Delivery of Preventive Services in Primary Care

描述（由申请人提供）：俄克拉何马大学家庭医学研究中心和俄克拉何马医生资源/研究网络与医疗数据解决方案公司（一家软件开发公司）合作，将研究多组分干预的有效性，以转化已知的三种办公室系统策略，以增加初级保健实践中免疫接种和其他预防服务的交付。转化干预将包括有反馈和基准的医疗记录审计，由当地意见领袖提供学术细节，包括来自同行范例的建议（“最佳实践研究”的结果），实践增强助手（实践推动者），以及旨在帮助实践纳入和维护办公系统战略的计算机应用程序。感兴趣的策略包括护士站立命令，召回和提醒系统，以及特殊免疫和预防服务诊所。实践将被随机分配到多组分干预组或对照组，后者将单独接受基准测试的反馈。主要的结果度量将是实践所采用的（三种）办公室系统策略的数量。上下文因素和障碍及其对采用办公系统战略的影响将进行分析。最后，我们还将比较选定的免疫接种和预防服务的提供率，以确定干预措施对提供预防服务的影响程度。这项为期两年的研究，虽然规模相对较小，但将有助于我们理解基于实践的研究网络中的多组分转化干预。

DESCRIPTION (Provided by Applicant): The Center for Family Medicine Research at the University of Oklahoma and the Oklahoma Physicians Resource/Research Network, in collaboration with Medical Data Solutions, Inc., (a software development company) will study the effectiveness of a multi-component intervention to translate three office system strategies known to increase delivery of immunizations and other preventive services in a group of primary care practices. The translational intervention will include medical record audits with feedback and benchmarking, academic detailing by a local opinion leader including suggestions derived from peer exemplars (results of "best practices research"), a practice enhancement assistant (practice facilitator), and a computer application designed to help the practice incorporate and maintain the office system strategies. The strategies of interest include nurse standing orders, a recall and reminder system, and special immunization and preventive services clinics. Practices will be randomized to the multi-component intervention group or to the control group, which will receive feedback with benchmarking alone. The primary outcome measure will be the number of office system strategies (of the three) adopted by the practice. Contextual factors and barriers and their impact on adoption of the office system strategies will analyzed. Finally, we will also compare the rates of delivery of selected immunizations and preventive services to determine the size of the effect of the intervention on preventive services delivery. This two-year study, though relatively small, will contribute to our understanding of multi-component translational interventions within practice-based research networks.