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




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Implementation Science

, 9:169

First Online: 23 November 2014Received: 14 May 2014Accepted: 05 November 2014DOI: 10.1186-s13012-014-0169-x

Cite this article as: Mold, J.W., Aspy, C.B., Smith, P.D. et al. Implementation Sci 2014 9: 169. doi:10.1186-s13012-014-0169-x

Abstract

BackgroundFour 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.

MethodsMotivated 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.

ResultsFollowing 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.

ConclusionsWith 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.

KeywordsImplementation Diffusion Primary care Practice-based research network Chronic kidney disease AbbreviationsA1cHemoglobin A1c

ACEIsAngiotensin converting enzyme inhibitors

ARBsAngiotensin receptor blockers

CIConfidence intervals

CKDChronic kidney disease

CMEContinuing medical education

CPCQChange process capability questionnaire

DBPDiastolic blood pressure

eGFREstimated glomerular filtration rates

EHRElectronic health record

GEEGeneralized estimating equations

HgbHemoglobin

LDLLow-density lipoprotein

LLCsLocal learning collaboratives

microalbuminUrine albumin-creatinine ratio

MOCMaintenance of certification

NSAIDSNon-steroidal anti-inflammatory medications

OKPRNOklahoma physicians resource-research network

OROdds ratio

PBRNPractice-based research networks

PFsPractice facilitators

PPC-PCMH-RPhysician practice connections — patient-centered medical home research version

QIQuality improvement

SBPSystolic blood pressure

Electronic supplementary materialThe online version of this article doi:10.1186-s13012-014-0169-x contains supplementary material, which is available to authorized users.

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Autor: James W Mold - Cheryl B Aspy - Paul D Smith - Therese Zink - Lyndee Knox - Paula Darby Lipman - Margot Krauss - D Robe

Fuente: https://link.springer.com/



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