PMID- 24821894
OWN - NLM
STAT- MEDLINE
DCOM- 20150206
LR  - 20211021
IS  - 1544-1717 (Electronic)
IS  - 1544-1709 (Print)
IS  - 1544-1709 (Linking)
VI  - 12
IP  - 3
DP  - 2014 May-Jun
TI  - Implementing asthma guidelines using practice facilitation and local learning 
      collaboratives: a randomized controlled trial.
PG  - 233-40
LID - 10.1370/afm.1624 [doi]
AB  - PURPOSE: Guideline implementation in primary care has proven difficult. Although 
      external assistance through performance feedback, academic detailing, practice 
      facilitation (PF), and learning collaboratives seems to help, the best 
      combination of interventions has not been determined. METHODS: In a cluster 
      randomized trial, we compared the independent and combined effectiveness of PF 
      and local learning collaboratives (LLCs), combined with performance feedback and 
      academic detailing, with performance feedback and academic detailing alone on 
      implementation of the National Heart, Lung and Blood Institute's Asthma 
      Guidelines. The study was conducted in 3 primary care practice-based research 
      networks. Medical records of patients with asthma seen during pre- and 
      postintervention periods were abstracted to determine adherence to 6 guideline 
      recommendations. McNemar's test and multivariate modeling were used to evaluate 
      the impact of the interventions. RESULTS: Across 43 practices, 1,016 patients met 
      inclusion criteria. Overall, adherence to all 6 recommendations increased (P 
      </=.002). Examination of improvement by study arm in unadjusted analyses showed 
      that practices in the control arm significantly improved adherence to 2 of 6 
      recommendations, whereas practices in the PF arm improved in 3, practices in the 
      LLCs improved in 4, and practices in the PF + LLC arm improved in 5 of 6 
      recommendations. In multivariate modeling, PF practices significantly improved 
      assessment of asthma severity (odds ratio [OR] = 2.5, 95% CI, 1.7-3.8) and 
      assessment of asthma level of control (OR = 2.3, 95% CI, 1.5-3.5) compared with 
      control practices. Practices assigned to LLCs did not improve significantly more 
      than control practices for any recommendation. CONCLUSIONS: Addition of PF to 
      performance feedback and academic detailing was helpful to practices attempting 
      to improve adherence to asthma guidelines.
FAU - Mold, James W
AU  - Mold JW
AD  - University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
FAU - Fox, Chester
AU  - Fox C
FAU - Wisniewski, Angela
AU  - Wisniewski A
FAU - Lipman, Paula Darby
AU  - Lipman PD
FAU - Krauss, Margot R
AU  - Krauss MR
FAU - Harris, D Robert
AU  - Harris DR
FAU - Aspy, Cheryl
AU  - Aspy C
FAU - Cohen, Rachel A
AU  - Cohen RA
FAU - Elward, Kurt
AU  - Elward K
FAU - Frame, Paul
AU  - Frame P
FAU - Yawn, Barbara P
AU  - Yawn BP
FAU - Solberg, Leif I
AU  - Solberg LI
FAU - Gonin, Rene
AU  - Gonin R
LA  - eng
GR  - R01 HL091827/HL/NHLBI NIH HHS/United States
GR  - HHS-5R01HL091827/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Ann Fam Med
JT  - Annals of family medicine
JID - 101167762
SB  - IM
MH  - Adult
MH  - Asthma/*therapy
MH  - Child
MH  - Feedback
MH  - Female
MH  - *Guideline Adherence
MH  - Humans
MH  - Male
MH  - Practice Guidelines as Topic
MH  - Primary Health Care/*methods/standards
MH  - Severity of Illness Index
PMC - PMC4018371
OTO - NOTNLM
OT  - asthma
OT  - practice facilitation
OT  - practice guidelines as topic
OT  - practice-based research network
OT  - primary health care
OT  - quality improvement
EDAT- 2014/05/14 06:00
MHDA- 2015/02/07 06:00
PMCR- 2014/11/01
CRDT- 2014/05/14 06:00
PHST- 2014/05/14 06:00 [entrez]
PHST- 2014/05/14 06:00 [pubmed]
PHST- 2015/02/07 06:00 [medline]
PHST- 2014/11/01 00:00 [pmc-release]
AID - 12/3/233 [pii]
AID - 0120233 [pii]
AID - 10.1370/afm.1624 [doi]
PST - ppublish
SO  - Ann Fam Med. 2014 May-Jun;12(3):233-40. doi: 10.1370/afm.1624.