Comparing traditional and participatory dissemination of a shared decision making intervention (ADAPT-NC): a cluster randomized trial

Implementation Science

Michael Dulin²  Sveta Mohanan¹  Diane Derkowski³  Jacquie Halladay⁴  Thamara Alkhazraji²  Yhenneko Taylor²  Lindsay Kuhn¹  Thomas Ludden²  Andrew McWilliams¹  Hazel Tapp¹ 

[1]Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Suite 400 Mercy Medical Plaza, Charlotte 28207, NC, USA

[2]Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, USA

[3]Carolinas Medical Center, Charlotte, USA

[4]Department of Family Medicine, UNC Chapel Hill and The Cecil G. Sheps Center for Health Services Research, Chapel Hill, USA

关键词: Decision aids;    Dissemination;    Facilitated implementation;    Shared decision making;    Asthma;   

Others  :  1139503
DOI  :  10.1186/s13012-014-0158-0

 received in 2014-09-17, accepted in 2014-10-07,  发布年份 2014

【 摘 要 】

Background

Asthma is a common disease that affects people of all ages and has significant morbidity and mortality. Poor outcomes and health disparities related to asthma result in part from the difficulty of disseminating new evidence and care delivery methods such as shared decision making (SDM) into clinical practice.

This 3-year study explores the ideal framework for rapid dissemination of an evidence-based SDM toolkit for asthma management. The study leverages a partnership between the North Carolina (NC) statewide Medicaid network and the NC Network Consortium of practice-based research networks (PBRNs).

Methods/design

This non-blinded study will randomize 30 primary care clinics in NC stratified by four PBRNs. We will test dissemination across these practices using a facilitator-led participatory approach to dissemination (FLOW), a novel method of participatory dissemination involving key principles of community-based participatory research, and a more typical ¿lunch and learn¿ dissemination method. Specifically, we will use cluster randomization to assign each of the 30 practices to one of three arms: (1) control, no dissemination; (2) traditional dissemination, one didactic session a year and distribution of educational material; and (3) FLOW dissemination. We hypothesize that at the unit of randomization, the clinic, patients in the FLOW dissemination arm will be more likely to share in their treatment decisions compared to patients in the traditional dissemination or control arms. All outcomes will be measured at the level of the clinic. Adoption of the SDM approach will be evaluated by 1) asthma exacerbations, 2) level of patient involvement in the decision making process, and 3) qualitative assessments from patients and providers.

The research question is: What dissemination strategy most effectively increases practice level adoption of a shared decision making approach to asthma management? This study will provide important data to support best practices in dissemination of an evidence-based toolkit and implementation of shared decision making into primary care practices.

Trial registration

The trial was registered on January 27, 2014 through the United States National Institutes of Health¿s ClinicalTrials.gov NCT02047929 webcite and funded by the Patient-Centered Outcomes Research Institute (PCORI).

【 授权许可】

   
2014 Tapp et al.; licensee BioMed Central Ltd.

【 图 表 】

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