TRANSLATING CHLAMYDIA SCREENING GUIDELINES INTO PRACTICE

女性中的性传播沙眼衣原体感染通常是无症状的，如果不治疗，会产生严重的后果。然而，来自团体健康合作组织(GHC)的研究表明，如果高危妇女接受筛查和治疗，这种影响可以减少(即PID减少56%)。在过去的两年里，GHC制定了基于证据的衣原体筛查指南，以开始将证据转化为实践。目的：评价实施指南的几种多方面策略的有效性。网站：GHC的30名员工模范门诊。方法：这是一项在提供者和患者水平上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，还有一种既有提供者特定的组件，又有患者特定的组件。特定于提供者的策略(在临床层面进行随机化)包括使用意见领袖、测量和反馈以及放置在巴氏测试试剂盒中的提示。针对患者的策略(对个别参与者进行随机化)包括在14-20岁女性图表中放置提示，作为基于纸质的测试，为未来的计算机化自动提示系统奠定基础。结果：将在基线和实施后对结果进行衡量。主要结果是在14-25岁女性中进行适当的衣原体筛查的比率。其他主要结果包括：1)HEDIS新措施定义的衣原体筛查率；2)提供者的知识、态度/信念、自我效能、做法、感知障碍和支持的变化；3)每名适当筛查的妇女的成本和每个干预措施的边际成本效益。次要结果包括衣原体试验阳性、产后妊娠和异位妊娠的发生率的变化。主要研究好处：据我们所知，这将是第一次在确定的HMO临床人群中评估基于概念的指南实施策略的研究。为了进一步增强普适性，我们将在网络模式的管理型护理环境中测试选定的实施策略。

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.