Improving the translation of research into primary care practice: results of a national quality improvement demonstration project.
BACKGROUND
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.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Ornstein
Steven
S
Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA. ornstesm@musc.edu
Nietert
Paul J
PJ
Jenkins
Ruth G
RG
Wessell
Andrea M
AM
Nemeth
Lynne S
LS
Rose
Heather L
HL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D005260:Female; D006123:Group Practice; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019982:Organizational Case Studies; D010865:Pilot Projects; D011320:Primary Health Care; D011331:Private Practice; D011787:Quality of Health Care