Leveraging Practice Based Research Networks to Accelerate Implementation and Diff

描述(由申请人提供)：自2002年以来，慢性肾脏疾病(CKD)的循证管理指南已提供给执业医生。有强有力的证据表明，初级保健医生实施这些指南可以延缓CKD的进展并降低死亡率。我们将使用基于证据的多组成部分实施战略(绩效反馈、学术细节、实践促进和IT支持)来帮助32个不同社区的32个初级保健实践，四个州中的每个八个，实施CKD指南。然后，我们将通过本地学习协作、跨实践现场访问和不那么密集的促进，帮助这些实践在相同的社区内将指南传播给额外的实践(每个初始实践两个新实践)。将对准则中概述的十个关键行动步骤中的每一个步骤的执行情况进行衡量。这些包括：1)慢性肾脏病的诊断；2)贫血的诊断；3)避免不安全的药物；4)指示药物(ACEI或ARB)的使用；5)小剂量阿司匹林的使用；6)HgbA1c的测定；7)HgbA1c的测定；8)BP&lt；130/80；9)HgabA1c&lt；7；和10)低密度脂蛋白胆固醇&100。假设所有96个实践都实施了指南，可以预期这种干预措施将改善大约20,000名慢性肾脏病患者的护理。在这个过程中，我们将评估实施和扩散战略对Solberg提出的实践变革模型的三个组成部分(变革的优先级、总体变革能力和变革过程内容)的影响。由于我们将为另外三个以实践为基础的研究网络(LANET、WREN、MAFPRN)、96个实践和32个实践社区提供循证质量改进方法方面的培训和经验，我们希望增加这些小组参与后续质量改进倡议以及未来实施和传播研究的可能性。 公共卫生相关性：我们建议使用循证策略，在四个不同州的32个不同社区中，在一个实践中促进慢性肾脏疾病指南的实施。然后，我们将帮助这些实践中的每一个将指导方针传播到这些社区中的另外两个实践，总共达到96个实践。战略将包括绩效反馈、学术细节、实践促进、信息技术支持、本地协作学习和实践间现场访问。

DESCRIPTION (provided by applicant): Evidence-based guidelines for management of chronic kidney disease (CKD) have been available to practicing physicians since 2002. There is strong evidence that implementation of these guidelines by primary care physicians can delay CKD progression and reduce mortality. We will use an evidence-based multi-component implementation strategy (performance feedback, academic detailing, practice facilitation, and IT support) to help 32 primary care practices in 32 different communities, eight in each of four states, implement the CKD guidelines. We will then help those practices spread the guidelines to 64 additional practices (two new practices for each initial practice) within those same communities using local learning collaborative, inter-practice site visits, and less intensive facilitation. Implementation will be measured for each of ten key action steps outlined in the guidelines. These include: 1) diagnosis of CKD; 2) diagnosis of anemia; 3) avoidance of unsafe medications; 4) use of indicated medications (ACEI or ARB); 5) use of low dose aspirin; 6) Measurement of HgbA1c; 7) measurement of Hgb; 8) BP < 130/80; 9) HgabA1c < 7; and 10) LDL cholesterol < 100. Assuming that all 96 practices implement the guidelines, this intervention can be expected to improve the care of approximately 20,000 patients will CKD. In the process, we will evaluate the impact of the implementation and diffusion strategies on the three components of the practice change model proposed by Solberg (priority for the change, overall change capacity, and change process content). Because we will be providing training and experience in evidence-based quality improvement methods to three additional practice-based research networks (LANet, WREN, MAFPRN), 96 practices, and 32 communities of practice, we hope to increase the likelihood that these groups will participate in subsequent quality improvement initiatives and in future implementation and diffusion research. PUBLIC HEALTH RELEVANCE: We propose to facilitate, using evidence-based strategies, implementation of chronic kidney disease guidelines in one practice in each of 32 different communities in four different states. We will then help each of those practices spread the guidelines to two additional practices within those same communities, reaching a total of 96 practices. Strategies will include performance feedback, academic detailing, practice facilitation, IT support, local learning collaborative, and inter-practice site visits.