title: A qualitative study of processes used to implement evidence-based care in a primary care practice.
abstract: BACKGROUND
  Evidence-based guidelines for care of coronary heart disease patients are not fully implemented. Primary care practices provide most of the care for these patients.
  
  
  OBJECTIVE
  To learn how providers and staff in a busy primary care practice implement interventions to provide evidence-based care of coronary heart disease patients.
  
  
  METHODS
  We conducted a qualitative analysis of the responses to open-ended questions in nine electronically administered bimonthly surveys of key physicians, clinic staff and managers in the practice.
  
  
  RESULTS
  Ten to 16 (mean=12.3) personnel responded to each survey. Nearly 30% were physicians and 40.5% were clinic staff. Four major themes emerged from the qualitative analysis: (i) giving data about not-at-goal patients to providers for care plan development; (ii) developing team roles and defining tasks; (iii) providing patient care and implementing care plans and (iv) providing technology support to generate useful, accurate data. The frequency that the subthemes were mentioned varied from survey to survey, but their mention persisted over the entire time of all nine surveys.
  
  
  CONCLUSIONS
  Developing a system for implementing evidence-based care involves considerations of roles and teamwork, technology use to develop a patient registry and obtain needed clinical data, care processes for pre-visit planning, and between-visit care management. A registered nurse care manager is a central figure in implementing and sustaining the process. Implementing evidence-based guidelines is an ongoing process of revision, retraining and reinforcement.
authors.affiliation: HealthPartners Institute for Education and Research, Bloomington, MN and jacquelyn.a.huebsch@healthpartners.com.
authors.forename: Jacquelyn A
authors.initials: JA
authors.lastname: Huebsch
authors.affiliation: HealthPartners Institute for Education and Research, Bloomington, MN and.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kottke
authors.affiliation: Hudson Physicians, Hudson, WI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: McGinnis
authors.affiliation: Hudson Physicians, Hudson, WI, USA.
authors.forename: Jolleen
authors.initials: J
authors.lastname: Nichols
authors.affiliation: HealthPartners Institute for Education and Research, Bloomington, MN and.
authors.forename: Emily D
authors.initials: ED
authors.lastname: Parker
authors.affiliation: HealthPartners Institute for Education and Research, Bloomington, MN and.
authors.forename: Juliana O
authors.initials: JO
authors.lastname: Tillema
authors.affiliation: HealthPartners Institute for Education and Research, Bloomington, MN and.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Hanson
mesh_terms: D003327:Coronary Disease / Q000628:therapy*; D057286:Electronic Health Records / Q000592:standards; D019317:Evidence-Based Medicine; D005246:Feedback; D006801:Humans; D024802:Nurse's Role; D009937:Organizational Objectives; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D016730:Program Development; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Delivery of healthcare; evidence-based practice; healthcare team; patient care management; primary care.