title: Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study.
abstract: 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.
authors.affiliation: Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th Street, Oklahoma City, OK, 73104, USA. james-mold@ouhsc.edu.
authors.forename: James W
authors.initials: JW
authors.lastname: Mold
authors.affiliation: Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th Street, Oklahoma City, OK, 73104, USA. caspy@cox.net.
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Aspy
authors.affiliation: University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI, 53715, USA. Paul.Smith@fammed.wisc.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Smith
authors.affiliation: Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA. therese.zink@wright.edu.
authors.forename: Therese
authors.initials: T
authors.lastname: Zink
authors.affiliation: Los Angeles Practice-Based Research Network (LA Net), 3940-B East Broadway, Long Beach, CA, 90803, USA. Lyndee.knox@gmail.com.
authors.forename: Lyndee
authors.initials: L
authors.lastname: Knox
authors.affiliation: Westat, 1600 Research Boulevard, Rockville, MD, 20850, USA. paulalipman@westat.com.
authors.forename: Paula Darby
authors.initials: PD
authors.lastname: Lipman
authors.affiliation: Westat, 1600 Research Boulevard, Rockville, MD, 20850, USA. margotkrauss@westat.com.
authors.forename: Margot
authors.initials: M
authors.lastname: Krauss
authors.affiliation: Westat, 1600 Research Boulevard, Rockville, MD, 20850, USA. bobharris@westat.com.
authors.forename: D Robert
authors.initials: DR
authors.lastname: Harris
authors.affiliation: State University of New York at Buffalo, 1315 Jefferson Avenue, Buffalo, NY, 14208, USA. chetfox@gmail.com.
authors.forename: Chester
authors.initials: C
authors.lastname: Fox
authors.affiliation: HealthPartners Institute for Education and Research, Mail Stop 23301, P.O. Box 1524, Minneapolis, MN, 55440-1524, USA. Leif.I.Solberg@HealthPartners.com.
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.affiliation: Westat, 1600 Research Boulevard, Rockville, MD, 20850, USA. rachelcohen@westat.com.
authors.forename: Rachel
authors.initials: R
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards; D004059:Diffusion of Innovation; D006292:Health Priorities; D006801:Humans; D015141:Los Angeles; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D008910:Minnesota; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011320:Primary Health Care / Q000592:standards*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D014922:Wisconsin