TRANSLATING CHLAMYDIA SCREENING GUIDELINES INTO PRACTICE

妇女性传播的沙眼衣原体感染，通常无症状，如果不及时治疗，会造成严重后果。然而，团体健康合作社（GHC）的研究表明，如果高危妇女接受筛查和治疗，这种影响可以降低（即PID降低56%）。在过去两年中，GHC制定了以证据为基础的衣原体筛查指南，以启动将证据转化为实践。目的：评价指导方针实施的几种多方面策略的有效性。地点：30名员工在GHC示范门诊诊所。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，我们将标准指南的实现与其他三种策略进行比较：一种仅包含特定于提供者的组件，一种仅包含特定于患者的组件，以及一种同时包含特定于提供者和患者的组件。针对提供者的策略（在诊所层面随机化）包括使用意见领袖、测量和反馈以及放置在巴氏试验包中的提示。患者特异性策略（随机分组）包括在14-20岁女性的图表中放置提示，作为基于纸张的测试，以建立未来计算机自动提示系统的案例。结果：结果将在基线和实施后进行测量。主要结果是14- 25岁女性中适当的衣原体筛查率。其他主要结局包括：1)由新的HEDIS指标定义的衣原体筛查率；2)提供者的知识、态度/信念、自我效能、实践以及感知到的障碍和支持的变化；3)每个妇女适当筛查的成本和每个干预组的边际成本效益。次要结局包括衣原体检测阳性率、PID和异位妊娠的变化。主要研究益处：据我们所知，这将是第一个在确定的HMO临床人群中评估基于概念的指南实施策略的研究。为了进一步提高通用性，我们将在网络模型管理式医疗设置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.