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Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care
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 sys...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729135/ https://www.ncbi.nlm.nih.gov/pubmed/26818455 http://dx.doi.org/10.1186/s12961-016-0079-2 |
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author | Quanbeck, Andrew Brown, Randall T E Zgierska, Aleksandra A Johnson, Roberta Robinson, James M Jacobson, Nora |
author_facet | Quanbeck, Andrew Brown, Randall T E Zgierska, Aleksandra A Johnson, Roberta Robinson, James M Jacobson, Nora |
author_sort | Quanbeck, Andrew |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4729135 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-47291352016-01-28 Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care Quanbeck, Andrew Brown, Randall T E Zgierska, Aleksandra A Johnson, Roberta Robinson, James M Jacobson, Nora Health Res Policy Syst Study Protocol 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. BioMed Central 2016-01-27 /pmc/articles/PMC4729135/ /pubmed/26818455 http://dx.doi.org/10.1186/s12961-016-0079-2 Text en © Quanbeck et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Study Protocol Quanbeck, Andrew Brown, Randall T E Zgierska, Aleksandra A Johnson, Roberta Robinson, James M Jacobson, Nora Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care |
title | Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care |
title_full | Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care |
title_fullStr | Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care |
title_full_unstemmed | Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care |
title_short | Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care |
title_sort | systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care |
topic | Study Protocol |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729135/ https://www.ncbi.nlm.nih.gov/pubmed/26818455 http://dx.doi.org/10.1186/s12961-016-0079-2 |
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