TRANSLATING CHLAMYDIA SCREENING GUIDELINES INTO PRACTICE

将衣原体筛查指南付诸实践

• 批准号: 6538172
• 负责人: Robert Sharpe Thompson
• 金额: $ 42万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2004-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6538172
• 关键词: Chlamydia trachomatis; adolescence (12-20); behavioral /social science research tag; chlamydial disease; clinical research; computer assisted patient care; female; health behavior; health care model; health care service evaluation; health care service utilization; health services research tag; human subject; managed care; mass screening; outcomes research; peer group; pelvic inflammatory disease; women's health; young adult human (21-34)

Sexually transmitted Chlamydia trachomatis infections in women, often asymptomatic, have serious consequences if left untreated. However, studies from Group Health Cooperative (GHC) have shown the impact can be decreased (i.e., a 56 percent decrease in PID) if at-risk women receive screening and treatment. Over the last two years, GHC has developed an evidence-based chlamydia screening guideline to initiate translation of the evidence into practice. Objective: To evaluate the effectiveness of several multifaceted strategies for guideline implementation. Site: Thirty staff model outpatient clinics at GHC. Methods: This is a randomized trial of guideline implementation strategies carried out at the provider and patient levels. Using a 2x2 factorial design, we will compare standard guideline implementation to three other strategies: one with only provider-specific components, one with only patient-specific components and one with both provider- and patient-specific components. Provider- specific strategies (with randomization occurring at the clinic level) include the use of opinion leaders, measurement and feedback, and prompts placed in Pap test kits. The patient- specific strategy (with randomization of individual enrollees) consists of a prompt placed in the chart of 14-20 year-old females as a paper-based test to establish the case for a future computerized automated prompt system. Outcomes: Outcomes will be measured at baseline and post-implementation. The primary outcome is the rate of appropriate chlamydia screening among 14- 25 year-old females. Other primary outcomes are 1) the rate of chlamydia screening as defined by a new HEDIS measure; 2) changes in provider knowledge, attitudes/beliefs, self-efficacy, practices, and perceived barriers and supports; 3) the cost per woman appropriately screened and the marginal cost-effectiveness of each intervention arm. Secondary outcomes include changes in the rates of positive chlamydia tests, PID and ectopic pregnancy. Major study benefits: To our knowledge this will be the first study to evaluate conceptually-based guideline implementation strategies in a defined HMO clinical population. In order to further enhance generalizability, we will test selected implementation strategies in a network-model managed care setting.

妇女性传播的沙眼衣原体感染，通常没有症状，如果不治疗，会产生严重后果。然而，来自团体健康合作社（GHC）的研究表明，这种影响可以减少（即，如果高危妇女接受筛查和治疗，PID下降56%。 在过去两年中，GHC制定了一项循证衣原体筛查指南，以开始将证据转化为实践。 目的：评价指南实施的多方面策略的有效性。地点：GHC的30名工作人员示范门诊部。 方法：这是一项在提供者和患者层面进行的指南实施策略的随机试验。 使用2x2析因设计，我们将比较标准指南的实施与其他三种策略：一种只有提供者特定的组件，一种只有患者特定的组件，一种同时具有提供者和患者特定的组件。 提供者特定的策略（随机化发生在诊所层面）包括使用意见领袖，测量和反馈，以及放置在巴氏试验试剂盒中的提示。 患者特异性策略（对个体入组者进行随机化）包括在14-20岁女性病历中放置一个提示，作为一项纸质测试，以确定未来计算机化自动提示系统的情况。 成果：将在基线和实施后衡量成果。 主要结果是14- 25岁女性中适当的衣原体筛查率。 其他主要结果是1）新的HEDIS测量定义的衣原体筛查率; 2）提供者知识、态度/信念、自我效能、实践和感知障碍和支持的变化; 3）适当筛查的每位妇女的成本和每个干预组的边际成本效益。次要结果包括阳性衣原体检测率、PID和异位妊娠率的变化。主要研究获益：据我们所知，这将是第一项在定义的HMO临床人群中评估基于概念的指南实施策略的研究。 为了进一步提高普遍性，我们将测试选定的实施策略，在网络模式的管理式医疗设置。