There is widespread evidence of inadequate translation of research findings into primary care practice. Theoretically sound demonstrations of how health care organizations can overcomes these deficiencies are needed. A demonstration project was conducted from January 1, 2003, through June 30, 2006, to evaluate the impact of a multicomponent intervention and improvement models intended to enhance adherence to clinical practice guidelines across eight broad clinical areas.
The demonstration project involving 530 clinicians and staff members from 99 primary practices in 36 states entailed practice performance reports (audit and feedback), practice site visits for academic detailing and participatory planning, and network meetings for sharing 4 of "best practice" approaches. Data from electronic medical records (EMRs) of 847,073 patients were abstracted to identify 31 process and 5 outcome quality measures for prevention and treatment of cardiovascular disease and diabetes, cancer screening, adult immunization, respiratory and infectious disease, mental health and substance abuse, obesity and nutrition, safe medication prescribing in the elderly, and a summary measure, the Summary Quality Index (SQUID).
The yearly adjusted absolute improvement in the SQUID was 2.43% (95% confidence interval [C.I.], 2.24%-2.63%). Clinically and statistically significant improvements occurred for 29 of the 36 quality measures, including all 5 outcome measures.
The findings suggest that a multicomponent quality improvement intervention involving audit and feedback, academic detailing and participatory planning activities, and sharing of "best practice" approaches in practices with EMRs can have a robust impact in quality of care for Americans seen in primary care practices.
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"Yet, due to those barriers, providers often miss CRCS opportunities for their patients  . Combining multiple provider-directed with officesystem-directed interventions in the primary care setting shows the most potential to increase CRCS rates    . "
[Show abstract][Hide abstract] ABSTRACT: It is recognized that physicians play an important role in responding to the nation's obesity epidemic. Little is known, however, about what physicians say to their obese patients to help them lose weight. Objective: This cross-sectional survey examined weight loss recommendations of family physicians and internists. Surveys were mailed to 188 physicians and 54% (n = 101) responded. The survey assessed physicians' weight loss recommendations, the basis for recommendations, and their expected weight loss outcomes for a hypothetical patient. Physicians rated the extent to which they recommended various weight control strategies to their obese patients. They also rated the extent to which clinical experience, personal experience, and the medical literature were important in formulating their recommendations.
The most common strategies recommended were increasing physical activity, reducing consumption of fast foods, reducing portion sizes, and reducing soda consumption. Physicians were less likely to recommended regular self-weighing, recording food intake, and decreasing television viewing. Meal replacements and weight loss medications were rarely advised. Physicians reported that they based their weight loss recommendations more on clinical experience than on the medical literature or personal experience; these latter 2 were rated as equally important. Physicians reported that, from their perspective, the equivalent of a 21.5% weight loss would be an "acceptable" outcome for a hypothetical obese patient; a 10.6% weight loss "disappointing."
Physicians, like patients, need to be educated about the benefits of modest weight loss and the weight loss strategies empirically proven to be most effective, including self-monitoring. Further research is needed to understand the barriers to recommending and implementing these effective strategies.
Full-text · Article · Mar 2009 · The Journal of the American Board of Family Medicine
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Half of Americans older than age 50 are not current with recommended screening; research is needed to assess the impact of interventions designed to increase receipt of CRC screening. The Colorectal Cancer Screening in Primary Care (C-TRIP) study is a theoretically informed group randomized trial within 32 primary care practices. Baseline median proportion of active patients aged 50 years or older up-to-date with CRC screening among the 32 practices was 50.8% (N = 55,746). Men were more likely to have been screened than women (52.9% vs. 49.2%, respectively). Patients 50 to 59 years of age were less likely to be up-to-date with screening (45.4%) than those in the 60 to 69 years and 70 to 79 years groups (58.5% in both groups). Opportunities exist to increase the proportion of CRC screening received in adults aged 50 and older. C-TRIP evaluates the effectiveness of a model for improvement for increasing this proportion.
Full-text · Article · Apr 2009 · Health Promotion Practice