Delivery of Preventive Services in Primary Care
Condition: Preventive Services; Immunizations; Screening
Study type: Interventional

Summary: 
      The major goal of this project is to determine the effectiveness of a multi-component
      intervention designed to help primary care practices implement three office system strategies
      known to increase delivery of immunizations and other preventive services. This two-year
      study will contribute to our understanding of multi-component translational interventions in
      primary care, and particularly within practice-based research networks.
    

Detailed description: 
      The multi-component translational intervention that we plan to test includes medical record
      audits with feedback and benchmarking, academic detailing by an opinion leader including
      information from literature review plus the advice of local exemplars, a practice
      facilitator, who will work with the practices over a six-month period, and an IT application
      that provides decision-support, prompts, and reminders to office staff and patients.

      The proposed project will be a randomized controlled trial of a multi-component strategy
      designed to facilitate the incorporation into primary care practices of three office
      management components known to increase preventive service delivery rates: 1) nurse standing
      orders; 2) special immunization/ preventive services "clinics;" and 3) recall and reminder
      systems. Twenty-four practices, all members of a primary care practice-based research
      network, will be enrolled and randomized to receive the complete intervention or performance
      feedback with benchmarking only. The primary outcomes will be number of management components
      implemented. Characteristics of clinicians and practices that are associated with greater or
      lesser success in implementing the three strategies and barriers encountered will also be
      examined, and we will measure and compare rates of selected immunizations and preventive
      services delivered.

      The specific aims for this project are to:

        1. Determine the effectiveness of a multi-component translational intervention on adoption
           of three strategies known to increase delivery of preventive services: nurse standing
           orders, a reminder/recall system (preferably PSRS), and special immunization and/or
           preventive services clinics. The intervention will include: a) performance feedback and
           benchmarking; b) training of clinicians and office staff in principles of effective
           preventive services (enhanced academic detailing by a physician opinion leader); c)
           practice enhancement assistants to facilitate office system changes; and d) an IT
           application that provides prompts and reminders to office staff, clinicians, and
           patients.

        2. Document contextual factors and barriers to the adoption of the three strategies and
           their impact on the intervention.

        3. Measure the impact of the intervention on rates of delivery of the following preventive
           services: DtaP#4, MMR#1, and HepB#3 in 2-3 year olds, and pneumococcal immunization,
           colorectal cancer screening, and mammography in adults 50 - 75 years of age.
    

Intervention name(s): Practice intervention; Practice intervention 2
Intervention type(s): Other; Other
Intervention description(s): Performance feedback, academic detailing, practice facilitation, IT support; Performance feedback only.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: translational research; prevention; primary care; practice-based research network