A multicomponent implementation strategy increases the use of care processes associated with higher rates of preventive services
Studies have shown that performance feedback and benchmarking alone have been relatively ineffective in improving delivery of preventive care by primary care physicians. A recent study by James W. Mold, M.D., and a team of researchers from the University of Oklahoma found that a multicomponent quality improvement strategy increased the use of standing orders, recall and reminder systems, and wellness visits more than a control strategy using only performance feedback and benchmarking.
The study compared the impact of the 2-part strategy with a broader strategy that included performance feedback, benchmarking, academic detailing, a practice facilitator, and information technology support on implementation of three processes of care previously shown to be associated with higher rates of delivery of preventive services. The latter included DTaP4, measles/mumps/rubella, and hepatitis-B#3 vaccines for 2- to 3-year-old children, and pneumonia vaccination, colorectal cancer screening, and mammography for 50 to 75-year-old adults.
Academic detailing consisted of one-on-one education of clinicians and key office staff about the three evidence-based preventive service delivery methods. Practice facilitators organized staff meetings, facilitated incremental improvements, trained staff, and audited patient charts to identify areas for improvement. Assistance, in information technology consisted of implementation of software to remind clinicians and staff in real time of a patient's need for preventive services.
Practices receiving the multicomponent intervention increased the number of evidence-based preventive service delivery strategies employed for both adults and children compared with control practices. As a general measure of improvements in processes of care associated with the interventions, the researchers also used a modified form of the Assessment of Chronic Illness Care (ACIC) survey instrument. The ACIC survey gave a higher score for improvement (0.77) to the practices receiving all five interventions, compared with 0.49 for the control group practices. All preventive services (except colorectal cancer) screening increased more among the intervention group than the control group, but mammography was the only preventive service to show a statistically significant increase. Neither clinician nor practice characteristics affected the measured outcomes. This study was supported by the Agency for Healthcare Research and Quality (HS14850).
See "Implementation of evidence-based preventive services delivery processes in primary care: An Oklahoma physicians resource/research network (OKPRN) study," by Dr. Mold, Cheryl A. Aspy, Ph.D., and Zsolt Nagykaldi, Ph.D. in the July-August 2008 Journal of the American Board of Family Medicine 21(4), pp. 334-344.
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