title: Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.
abstract: BACKGROUND
  Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction.
  
  
  METHODS
  The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis.
  
  
  CONCLUSIONS
  The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA. andrew.quanbeck@chess.wisc.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Quanbeck
authors.affiliation: School of Medicine and Public Health, University of Wisconsin-Madison, Room 3832, 1100 Delaplaine Ct, Madison, WI, 53715, USA. randy.brown@fammed.wisc.edu.
authors.forename: Randall T
authors.initials: RT
authors.lastname: Brown
authors.affiliation: School of Medicine and Public Health, University of Wisconsin-Madison, Room 3832, 1100 Delaplaine Ct, Madison, WI, 53715, USA. aleksandra.zgierska@fammed.wisc.edu.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: E Zgierska
authors.affiliation: Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, 1513 University Ave., Madison, WI, 53706, USA. bobbie.johnson@chess.wisc.edu.
authors.forename: Roberta
authors.initials: R
authors.lastname: A Johnson
authors.affiliation: Center for Health Systems Research & Analysis, University of Wisconsin-Madison, 1109c Warf Office Building, 610 Walnut St., Madison, WI, 53726, USA. jim@chsra.wisc.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Robinson
authors.affiliation: School of Nursing, University of Wisconsin-Madison, 5130 Cooper Hall, Signe Skott; 701 Highland Ave, Madison, WI, 53705, USA. najacobson@wisc.edu.
authors.forename: Nora
authors.initials: N
authors.lastname: Jacobson
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003253:Consultants; D003365:Costs and Cost Analysis; D055317:Evidence-Based Practice / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D012107:Research Design
chemical_list: D000701:Analgesics, Opioid
references.citation: Ann Intern Med. 2010 Jan 19;152(2):123-4
references.pmid: 20083830
references.citation: Implement Sci. 2013;8:139
references.pmid: 24289295
references.citation: J Pain. 2009 Feb;10(2):113-30
references.pmid: 19187889
references.citation: Addiction. 2013 Jun;108(6):1145-57
references.pmid: 23316787
references.citation: Adv Alcohol Subst Abuse. 1985 Fall-1986 Winter;5(1-2):163-73
references.pmid: 2870626
references.citation: JAMA. 2012 Mar 28;307(12):1257-8
references.pmid: 22453564
references.citation: JAMA. 2003 Apr 16;289(15):1969-75
references.pmid: 12697800
references.citation: J Gen Intern Med. 2010 Sep;25(9):936-41
references.pmid: 20458550
references.citation: Implement Sci. 2008 Oct 27;3:45
references.pmid: 18954465
references.citation: J Pain Palliat Care Pharmacother. 2002;16(1):105-9
references.pmid: 14650454
references.citation: Issue Brief (Commonw Fund). 2012 Jun;15:1-14
references.pmid: 22712103
references.citation: JAMA. 2011 Apr 6;305(13):1299-301
references.pmid: 21467282
references.citation: JAMA. 2001 Nov 28;286(20):2578-85
references.pmid: 11722272
references.citation: Eval Health Prof. 2013 Mar;36(1):44-66
references.pmid: 22615498
references.citation: Adm Policy Ment Health. 2011 Mar;38(2):65-76
references.pmid: 20957426
references.citation: Drug Alcohol Depend. 2007 May 11;88(2-3):138-45
references.pmid: 17129680
references.citation: Annu Rev Public Health. 2009;30:151-74
references.pmid: 19705558
references.citation: Med Care. 1991 Dec;29(12):1212-25
references.pmid: 1745079
references.citation: BMJ. 2001 Mar 17;322(7287):654-7
references.pmid: 11250852
references.citation: Qual Health Res. 2005 Nov;15(9):1277-88
references.pmid: 16204405
references.citation: BMJ. 1994 Jun 4;308(6942):1488-92
references.pmid: 8019284
references.citation: Fam Med. 2005 Sep;37(8):581-8
references.pmid: 16145629
references.citation: Drug Alcohol Depend. 2010 Nov 1;112(1-2):90-8
references.pmid: 20634006
references.citation: Lancet. 2009 Aug 8;374(9688):444-5
references.pmid: 19681190
references.citation: Ann Intern Med. 2010 Jan 19;152(2):85-92
references.pmid: 20083827
references.citation: J Contin Educ Health Prof. 2004 Fall;24 Suppl 1:S31-7
references.pmid: 15712775
references.citation: Milbank Q. 2010 Dec;88(4):500-59
references.pmid: 21166868
references.citation: J Pain Symptom Manage. 1996 Apr;11(4):203-17
references.pmid: 8869456
references.citation: Am Psychol. 2000 Jan;55(1):68-78
references.pmid: 11392867
references.citation: Health Aff (Millwood). 2011 Aug;30(8):1420-4
references.pmid: 21821559
references.citation: Drug Alcohol Depend. 2008 Nov 1;98(1-2):63-9
references.pmid: 18565693
references.citation: Fam Pract. 2011 Feb;28(1):12-21
references.pmid: 20833704
references.citation: Am J Public Health. 1999 Sep;89(9):1322-7
references.pmid: 10474547
references.citation: Milbank Q. 2005;83(4):843-95
references.pmid: 16279970
references.citation: Pharmacoepidemiol Drug Saf. 2009 Dec;18(12):1166-75
references.pmid: 19718704
references.citation: Psychol Sci Public Interest. 2008 Nov;9(2):67-103
references.pmid: 20865146
references.citation: Int J Qual Health Care. 2008 Feb;20(1):22-30
references.pmid: 18073269
references.citation: Health Care Manage Rev. 1995 Spring;20(2):16-33
references.pmid: 7607882
references.citation: JAMA. 2011 Apr 6;305(13):1315-21
references.pmid: 21467284
references.citation: Lancet. 2003 Oct 11;362(9391):1225-30
references.pmid: 14568747