Article Figures & Data
Tables
Practice Characteristic LLC PF PF + LLC Control P Valuea Participating practices, No. 10 10 12 11 NA Medical record type, No. (%) Electronic health record 4 (40) 8 (80) 9 (75) 5 (45) .14 Paper 6 (60) 2 (20) 3 (25) 6 (55) Mid-level practitioners, No. (%) Yes 6 (60) 6 (60) 9 (75) 6 (55) .76 No 4 (40) 4 (40) 3 (25) 5 (45) Practice size, No. (%) 1 3 (30) 2 (20) 2 (17) 2 (18) .67 2 2 (20) 2 (20) 3 (25) 2 (18) 3–5 4 (40) 1 (10) 3 (25) 5 (45) ≥6 1 (10) 5 (50) 4 (33) 2 (18) Clinician owned, No. (%) Yes 6 (60) 5 (50) 5 (42) 4 (36) .72 No 4 (40) 5 (50) 7 (58) 7 (64) -
LLC = local learning collaborative; PF = practice facilitation.
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↵a P values were obtained from the Fisher exact test of the Fisher-Freman-Halton exact test.
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Study Population of Interest Outcome Measure Matched Pairs No. Preintervention % Postintervention % Change % P Valuea All asthmatic patients Assessment of asthma severity 977 37 56 19 <.001 Assessment of environmental triggers 1,016 38 52 14 <.001 Asthma action plan 983 7 11 4 .002 At each asthma visit Assessment of level of control 937 40 56 16 <.001 All patients with persistent asthma Asthma controller medications 867 82 87 5 .002 Primary asthma visit Asthma follow-up visits 410 72 79 7 .002 -
↵a Obtained from McNemar test.
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Study Population of Interest Outcome Measure Control PF LLC PF + LLC No. Pre % Post % No. Pre % Post % No. Pre % Post % No. Pre % Post % All asthmatic patients Assessment of asthma severity 188 45 56a 283 42 71a 196 28 39a 310 33 52a Assessment of environmental triggers 192 58 70a 290 42 57a 202 17 24 332 36 54a Asthma action plan 180 13 15 282 7 10 199 3 8b 322 7 11 At each asthma visit Assessment of level of control 172 44 45 276 55 73a 276 24 45a 301 34 54a All patients with persistent asthma Asthma controller medications 153 79 80 254 84 87 188 78 87b 289 84 91b Primary asthma visit Asthma follow-up visits 66 62 70 111 78 83 78 65 72 155 74 84b - Table 4
Multivariable Modeling of the Pre- to Postintervention Change in the Outcome Measures by Study Arm
Variable Assessment of Asthma Severity OR (95% CI) Assessment of Environmental Triggers OR (95% CI) Asthma Action Plan OR (95% CI) Assessment of Level of Contro OR (95% CI) Asthma Controller Medications OR (95% CI) Asthma Follow-up Visits OR (95% CI) Interaction of study arm with study period LLC 0.5 (0.3–0.7) … … 0.8 (0.5–1.2) … … PF 2.5 (1.7–3.8) … … 2.3 (1.5–3.5) … … PF + LLC 1.0 (0.7–1.5) … … 1.1 (0.7–1.7) … … Control 1.0 … … 1.0 … … P value .002 .58 . 24 .005 .24 .83 Medical record type Electronic 0.6 (0.5,−0.8) 1.6 (1.1–2.2) 0.6 (0.4–0.9) Paper 1.0 1.0 1.0 P value <.001 .005 .020 … … … Mid-level practitioners Yes 1.8 (1.3–2.4) … 0.5 (0.3, 0.9) … … … No 1.0 … 1.0 … … P value <.001 … .011 … … … Practice size 1 … 0.7 (0.4–1.1) 0.3 (0.1–0.8) 1.0 (0.7–1.5) … 1.5 (0.7–3.2) 2 … 1.9 (1.4–2.6) 1.5 (0.9–2.4) 1.5 (1.2–2.0) … 3.0 (1.6–5.5) 3–5 … 1.6 (1.1–2.4) 0.9 (0.5–1.7) 0.8 (0.6–1.1) … 1.2 (0.7–2.1) ≥6 … 1.0 1.0 1. 0 … 1.0 P value … <.0 01 <.0 01 <. 0 01 … .001 Clinician owned Yes … 1.6 (1.3–2.1) … 1.5 (1.2–1.9) … 0.3 (0.2–0.5) No … 1.0 … 1.0 … 1.0 P value … <.001 … <.001 … <.001 Region New York 0.6 (0.5–0.8) 1.3 (1.0–1.6) 0.2 (0.2–0.4) 1.5 (1.2–1.9) 0.7 (0.5–0.9) 1.9 (1.3–3.0) Oklahoma 1.0 1.0 1.0 1.0 1.0 1.0 P value <.001 .038 <.001 <.001 .006 .004 -
LLC = local learning collaborative; OR = odds ratio; PF = practice facilitation.
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Additional Files
Supplemental Appendix
Supplemental Appendix: Pre- to Postintervention Change in Proportion of Patients where the Guidelines were Implemented by Practice
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Implementing Asthma Guidelines Using Practice Facilitation and Local Learning Collaboratives: A Randomized Controlled Trial
James W. Mold , and colleagues
Background Implementing clinical practice guidelines for managing chronic diseases can be challenging for primary care practices. Two promising types of assistance are practice facilitation (PF) and learning collaboratives. This study compares the effectiveness of these two interventions, along with performance feedback and education (academic detailing) on practices' success in implementing the National Heart, Lung and Blood Institute's Asthma Guidelines.
What This Study Found Practice facilitation appears to be better than education, practical tools and performance feedback alone in helping primary care practices implement asthma guidelines. The intensity of the intervention appears to correlate with effectiveness.
Implications
- These findings may help efforts to improve guideline implementation in primary care practices.
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