Translating COPD Guidelines inot Primary Care Practice

将慢性阻塞性肺病指南转化为初级保健实践

• 批准号: 7893158
• 负责人: DONNA R PARKER
• 金额: $ 71.86万
• 依托单位: MEMORIAL HOSPITAL OF RHODE ISLAND
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-22 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7893158
• 关键词: Academic Detailing; Adherence; Affect; Algorithms; American; Behavioral; Boxing; Caring; Cause of Death; Chest; Cholesterol; Chronic Obstructive Airway Disease; Clinical Trials Design; Computer software; Data Collection; Decision Making; Development; Diagnosis; Disease; Economic Burden; Effectiveness; Effectiveness of Interventions; European; Evaluation; Feedback; Focus Groups; Gold; Grant; Guideline Adherence; Guidelines; Health; Health Personnel; Healthcare Systems; Individual; Intervention; Lead; Lung; National Heart, Lung, and Blood Institute; Needs Assessment; New England; Online Systems; Outcome; Patient Education; Patients; Patients' Rooms; Performance; Phase; Physicians; Physicians' Offices; Prevention; Primary Care Physician; Primary Health Care; Provider; Quality of Care; Randomized; Randomized Clinical Trials; Recommendation; Rhode Island; Risk; Screening procedure; Societies; Symptoms; Technology; Testing; Translating; Translations; United States; Update; arm; base; chronic care model; clinical practice; clinically relevant; compliance behavior; computerized; cost; design; disorder risk; evidence base; improved; patient education handout; point of care; programs; public health relevance; respiratory; tool; treatment as usual

DESCRIPTION (provided by applicant): This project will evaluate the translation of the Gold (the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease) COPD guidelines into primary care practice. This study is based upon the premise that an informed, activated patient will interact with a prepared, proactive team to improve COPD screening, diagnosis and management. Testing a similar hypothesis and using a similar design, the project team has demonstrated a successful translation of the NHLBI ATP III cholesterol guidelines into clinical practice. During phase 1, a needs assessment will evaluate barriers and facilitators to implementation of COPD guidelines into clinical practice through focus groups of primary care patients and providers. Using formative evaluation and feedback from the focus groups, three tools will be developed, refined and pilot tested. These include: a computerized patient activation tool that will be placed in each primary care office's waiting room for patient use; a [web-based], interactive COPD guidelines tool to be used by primary care providers as a decision support tool at the point of care and a COPD patient education toolbox to be used by the practice team. During phase 2, a block, randomized design cluster trial will be performed with one year of intervention within non-academic primary care practices (30 practices) throughout the state of Rhode Island and southeastern MA. The effectiveness of the materials developed in phase I will be tested in phase II regarding physician performance of COPD guideline implementation and the improvement in the clinically relevant outcomes (appropriate screening, diagnosis and management of COPD) compared to usual care. We will also examine the use of a patient activation tool - 'MyLungAge' to prompt patients to talk with their health care provider regarding their lung health and risk for COPD. Products for dissemination from this grant will include the results of the focus groups barriers and facilitators to implementation and adherence to COPD guidelines, a computerized data collection module for quality of care assessment regarding COPD guidelines, a refined computerized patient activation tool, an enhanced [web-based] COPD interactive guideline tool, tailored academic detailing materials, and the results of the randomized clinical trial on the effectiveness of these tools to improve COPD guideline adherence in primary care practice. Public Health Relevance Statement: This project will evaluate the translation of the Gold (the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease) COPD guidelines into primary care practice. During phase 1, a needs assessment will evaluate barriers and facilitators to implementation of COPD guidelines into clinical practice through focus groups of primary care patients and providers. Using formative evaluation and feedback from the focus groups, three tools will be developed, refined and pilot tested. The effectiveness of the materials developed in phase I will be tested in phase II (an RCT conducted with one year of intervention within non-academic primary care practices) regarding physician performance of COPD guideline implementation and the improvement in the clinically relevant outcomes (appropriate screening, diagnosis and management of COPD) compared to usual care.

描述（由申请人提供）：该项目将评估黄金（全球诊断，管理和预防慢性阻塞性肺疾病的策略）COPD指南为初级保健实践。这项研究基于以下前提：一个知情的，激活的患者将与准备好的积极的团队互动，以改善COPD筛查，诊断和管理。该项目团队测试了类似的假设并使用类似的设计，已经证明了NHLBI ATP III胆固醇指南的成功翻译为临床实践。在第1阶段，需求评估将评估障碍和促进者通过焦点小组的初级保健患者和提供者将COPD指南实施到临床实践中。使用焦点小组的形成性评估和反馈，将开发，完善并测试三个工具。其中包括：一个计算机化的患者激活工具，该工具将放置在每个初级保健办公室的候诊室中供患者使用； [基于Web]的交互式COPD指南工具将由初级保健提供者用作护理点的决策支持工具，而实践团队将使用COPD患者教育工具箱。在第2阶段，将在整个罗德岛州和马萨诸塞州东南部的非学术初级保健实践（30种实践）中进行一年的干预（30种实践）进行一年的干预。与常规护理相比，在第二阶段中开发的材料的有效性将在第二阶段中测试有关COPD指南实施的医师绩效以及临床相关结果的改善（适当的筛查，诊断和管理）。我们还将研究患者激活工具的使用 - “ mylungage”促使患者就其肺部健康和COPD风险进行与医疗保健提供者进行交谈。从这笔赠款中传播的产品将包括焦点小组障碍和促进者的实施和遵守COPD指南的结果，COPD指南是一个计算机化数据收集模块，用于COPD的护理质量评估 指南，一种精制的计算机化患者激活工具，一种增强的[基于Web] COPD Interactive 指南工具，量身定制的学术详细材料以及这些工具有效性提高COPD指南遵守初级保健实践中的有效性的随机临床试验结果。 公共卫生相关性声明：该项目将评估黄金的翻译（全球诊断，管理和预防慢性阻塞性肺部疾病的战略）COPD指南为初级保健实践。在第1阶段，需求评估将评估障碍和促进者通过焦点小组的初级保健患者和提供者将COPD指南实施到临床实践中。使用焦点小组的形成性评估和反馈，将开发，完善并测试三个工具。第I阶段开发的材料的有效性将在第二阶段（在非学术初级保健实践中进行一年干预的RCT），涉及COPD指南实施的医师绩效和临床相关结果的改善（适当的筛查（适当的筛查） ，与通常的护理相比，COPD的诊断和管理。