TY - JOUR
T1 - Systems consultation
T2 - Protocol for a novel implementation strategy designed to promote evidence-based practice in primary care
AU - Quanbeck, Andrew
AU - Brown, Randall T.
AU - Zgierska, Aleksandra
AU - Johnson, Roberta
AU - Robinson, James M.
AU - Jacobson, Nora
N1 - Funding Information:
This protocol was funded under the United States National Institute of Health’s R34 funding mechanism, the purpose of which is to “provide support for the initial development of a clinical trial or research project.” In this case, the funding will support a pilot study of the SCS to prepare for a large randomized control trial that will test the SCS against alternative approaches to EBP adoption in primary care. The SCS (1) teams clinical guideline writers with implementation specialists and primary care physicians to translate guidelines into a checklist-based implementation guide; (2) selects, trains, and deploys physician peer coaches (systems consultants) to help primary care clinicians implement EBPs using evidence-based tools of systems engineering; and (3) focuses on process as a cause of variation in outcomes. Although the SCS is rooted in established theory and empirical research, the approach has not been formally tested. This pilot test is intended to answer questions about the feasibility, acceptability, and preliminary effectiveness of the approach by studying adaptations that will be made to tailor the NIATx approach to primary care. In the future randomized trial, we will assess the costs and effects of the SCS versus other implementation strategies (such as audit/feedback or academic detailing) to determine the most cost-effective approach for reducing variation in opioid prescribing practices.
Funding Information:
The National Institute on Drug Abuse (NIDA) is the primary funder of the study (R34-DA-036720-01). The funder has no role in study design, the interpretation of data, or the publication of results. Additional support is provided by grants from the National Institute on Drug Abuse (R01–DA– 034279–01, R01–DA–030431– 01, and K01-DA-039336-01). The authors wish to thank the distinguished experts who took part in translating the clinical guideline for opioid prescribing for use in this study, including, from pain management, the experts who developed the guideline for opioid prescribing, Jane Ballantyne, MD, Roger Chou, MD, and Perry Fine, MD; from healthcare quality improvement and implementation, David H. Gustafson, PhD, Dennis McCarty, PhD, and Paul Batalden, MD; and from community-based family medicine, Jonas Lee, MD, Beth Potter, MD, and John Frey, MD. The authors also wish to thank the expert systems consultant, Lynn M. Madden, who is advising the systems consultants in the study, and the dedicated staff who helped plan and conduct the study, Brienna M. Deyo, Wen-Jen Tuan, Esra Alagoz, Ellyn Klaila, and Judith Ganch.
Funding Information:
Authors Quanbeck and Johnson have a shareholder interest in CHESS Mobile Health, a small business that develops web-based healthcare technology for patients and family members. This relationship is extensively managed by the authors and the University of Wisconsin. Dr. Quanbeck provides consulting through the NIATx Foundation, a non-profit organization that offers training in quality improvement. Dr. Zgierska has funding from Pfizer to conduct studies related to opioid prescribing practices. All the other authors declare no competing interests.
Publisher Copyright:
© 2016 Quanbeck et al.
PY - 2016/1/27
Y1 - 2016/1/27
N2 - Background: Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. Methods/Design: The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. Discussion: The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.
AB - Background: Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. Methods/Design: The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. Discussion: The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.
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U2 - 10.1186/s12961-016-0079-2
DO - 10.1186/s12961-016-0079-2
M3 - Article
C2 - 26818455
AN - SCOPUS:84957108352
SN - 1478-4505
VL - 14
JO - Health Research Policy and Systems
JF - Health Research Policy and Systems
IS - 1
M1 - 8
ER -