Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study

Implementation Science

Rachel Cohen¹  Leif I Solberg²  Chester Fox⁵  D Robert Harris¹  Margot Krauss¹  Paula Darby Lipman¹  Lyndee Knox³  Therese Zink⁴  Paul D Smith⁶  Cheryl B Aspy⁷  James W Mold⁷ 

[1] Westat, 1600 Research Boulevard, Rockville 20850, MD, USA;HealthPartners Institute for Education and Research, Mail Stop 23301, Minneapolis 55440-1524, MN, USA;Los Angeles Practice-Based Research Network (LA Net), 3940-B East Broadway, Long Beach 90803, CA, USA;Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton 45435, OH, USA;State University of New York at Buffalo, 1315 Jefferson Avenue, Buffalo 14208, NY, USA;University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison 53715, WI, USA;Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th Street, Oklahoma City 73104, OK, USA

关键词: Chronic kidney disease;    Practice-based research network;    Primary care;    Diffusion;    Implementation;   

Others  :  1139482
DOI  :  10.1186/s13012-014-0169-x

 received in 2014-05-14, accepted in 2014-11-05,  发布年份 2014

【 摘 要 】

Background

Four practice-based research networks (PBRNs) participated in a study to determine whether networks could increase dissemination, implementation, and diffusion of evidence-based treatment guidelines for chronic kidney disease by leveraging early adopter practices.

Methods

Motivated practices from four PBRNs received baseline and periodic performance feedback, academic detailing, and weekly practice facilitation for 6 months during wave I of the study. Each wave I practice then recruited two additional practices (wave II), which received performance feedback and academic detailing and participated in monthly local learning collaboratives led by the wave I clinicians. They received only monthly practice facilitation. The primary outcomes were adherence to primary care-relevant process-of-care recommendations from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Guidelines. Performance was determined retrospectively by medical records abstraction. Practice priority, change capacity, and care process content were measured before and after the interventions.

Results

Following the intervention, wave I practices increased the use of ACEIs/ARBs, discontinuation of NSAIDs, testing for anemia, and testing and/or treatment for vitamin D deficiency. Most were able to recruit two additional practices for wave II, and wave II practices also increased their use of ACEIs/ARBs and testing and/or treatment of vitamin D deficiency.

Conclusions

With some assistance, early adopter practices can facilitate the diffusion of evidence-based approaches to other practices. PBRNs are well-positioned to replicate this process for other evidence-based innovations.

【 授权许可】

   
2014 Mold et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Mold JW, Peterson KA: Primary care practice-based research networks: working at the interface between research and quality improvement. Ann Fam Med 2005, 3(Suppl 1):S12-S20.
• [2]Riley WT, Glasgow RE, Etheredge L, Abernethy AP: Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise. Clin Transl Med 2013, 2(1):1-6. BioMed Central Full Text
• [3]Williams RL, Rhyne RL: No longer simply a practice-based research network (PBRN) health improvement networks. J Am Board Fam Med 2011, 24(5):485-488.
• [4]Lipman PD, Lange CJ, Cohen RA, Peterson KA: A mixed methods study of research dissemination across practice-based research networks. J Ambul Care Manage 2014, 37(2):179-188.
• [5]Aspy CB, Enright M, Halstead L, Mold JW: Improving mammography screening using best practices and practice enhancement assistants: an Oklahoma Physicians Resource/Research Network (OKPRN) study. J Am Board Fam Med 2008, 21(4):326-333.
• [6]Hogg W, Baskerville N, Lemelin J: Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost consequences analysis. BMC Health Serv Res 2005, 5(1):20. BioMed Central Full Text
• [7]Mold JW, Aspy CA, Nagykaldi Z: Implementation of evidence-based preventive services delivery processes in primary care: an Oklahoma Physicians Resource/Research Network (OKPRN) study. J Am Board Fam Med 2008, 21(4):334-344.
• [8]Mold JW, Fox C, Wisniewski A, Darby Lipman P, Krauss MR, Harris RD, Aspy C, Cohen RA, Elward K, Frame P, Yawn B, Solberg L, Gonin R: Helping primary care practices implement asthma guidelines: a randomized controlled trial comparing practice facilitation and local learning collaboratives.Ann Fam Med. in press
• [9]Nagykaldi Z, Mold JW, Robinson A, Niebauer L, Ford A: Practice facilitators and practice-based research networks. J Am Board Fam Med 2006, 19(5):506-510.
• [10]Nagykaldi Z, Mold JW: The role of health information in the translation of research into practice. J Am Board Fam Med 2002, 20(2):188-195.
• [11]Nagykaldi Z, Mold JW: Diabetes patient tracker, a personal digital assistant-based diabetes management system for primary care practices in Oklahoma. Diabetes Technol Ther 2003, 5(6):997-1001.
• [12]Rogers EM: Change agents. In Diffusion of Innovations. 5th edition. The Free Press, New York, NY; 2003:168-218.
• [13]Lineker SC, Bell MJ, Boyle J, Badley EM, Flakstad L, Fleming J, Lyddiatt A, MacDonald J, McCarthy J, Zummer M: Implementing arthritis clinical practice guidelines in primary care. Med Teach 2009, 31(3):230-237.
• [14]Ayers LR, Beyea SC, Godfrey MM, Harper DC, Nelson EC, Batalden PB: Quality improvement learning collaboratives. Qual Manag Health Care 2005, 14(4):234-247.
• [15]McMullen CK, Schneider J, Firemark A, Davis J, Spofford M: Cultivating engaged leadership through a learning collaborative: lessons from primary care renewal in Oregon safety net clinics. Ann Fam Med 2013, 11(Suppl 1):S34-S40.
• [16]Mangione-Smith R, Schonlau M, Chan KS, Keesey J, Rosen M, Louis TA, Keeler E: Measuring the effectiveness of a collaborative for quality improvement in pediatric asthma care: does implementing the chronic care model improve processes and outcomes of care? Ambul Pediatr 2005, 5(2):75-82.
• [17]Aspy CB, Mold JW, Thompson DM, Blondell RD, Landers PS, Reilly KE, Wright-Eakers L: Integrating screening and interventions for unhealthy behaviors into primary care practices. Am J Prev Med 2008, 35(5 Suppl):S373-S380.
• [18][http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/KU_Diseases_Stats_508.pdf] webcite Kidney Disease Statistics for the United States. []
• [19]Keith DS, Nichols GA, Guillion CM, Brown JB, Smith DH: Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004, 164(6):659-663.
• [20]K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification Am J Kidney Dis 2002, 39(2 Suppl 1):S1-S266.
• [21]Jafar TH, Stark PC, Schmid CH, Strandgaard S, Kamper AL, Maschio G, Becker G, Perrone RD, Levey AS: The effect of angiotensin-converting-enzyme inhibitors on progression of advanced polycystic kidney disease. Kidney Int 2005, 67(1):265-271.
• [22]Gooch K, Culleton BF, Manns BJ, Zhang J, Alfonso H, Tonelli M, Frank C, Klarenbach S, Hemmelgarn BR: NSAID use and progression of chronic kidney disease. Am J Med 2007, 120(3):e1-7.
• [23]Gouva C, Nikolopoulos P, Ioannidis JP, Siamopoulos KC: Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int 2004, 66(2):753-760.
• [24]Shepherd J, Kastelein JJ, Bittner V, Deedwania P, Breazna A, Dobson S, Wilson DJ, Zuckerman A, Wenger NK: Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the TNT (Treating to New Targets) study. J Am Coll Cardiol 2008, 51(15):1448-1454.
• [25]Schonlau M, Mangione-Smith R, Chan KS, Keesey J, Rosen M, Louis TA, Wu SY, Keeler E: Evaluation of a quality improvement collaborative in asthma care: does it improve processes and outcome of care? Ann Fam Med 2005, 3(3):200-208.
• [26]Hulscher ME, Wensing M, van Der Weijden T, Grol R: Interventions to implement prevention in primary care. Cochrane Database Syst Rev 2001, 1:CD000362.
• [27]Solberg LI, Crain AL, Jaeckels N, Ohnsorg KA, Margolis KL, Beck A, Whitebird RR, Rossom RC, Crabtree BF, Van de Ven AH: The DIAMOND initiative: implementing collaborative care for depression in 75 primary care clinics. Implement Sci 2013, 8:135. BioMed Central Full Text
• [28]Solberg LI: Improving medical practice: a conceptual framework. Ann Fam Med 2007, 5(3):251-256.
• [29]Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009, 4:50. BioMed Central Full Text
• [30]Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004, 82(4):581-629.
• [31]Grumbach K, Mold JW: A health care cooperative extension service: transforming primary care and community health. JAMA 2009, 301(24):2589-2591.
• [32]Phillips RL Jr, Kaufman A, Mold JW, Grumbach K, Vetter-Smith M, Berry A, Burke BT: The primary care extension program: a catalyst for change. Ann Fam Med 2013, 11(2):173-178.