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Involving all staff members in guideline-recommended care can improve oversight and coordination of patient care

Involving all primary care staff members in practice activities and assuring that they all become familiar with clinical practice guidelines can improve oversight, coordination of patient care, and outcomes. A quality improvement model to accomplish this was developed during a Practice Partner Research Network (PPRNet) Translating Research into Practice (TRIP) project, supported by the Agency for Healthcare Research and Quality (HS11132). The goal was to help practices improve primary and secondary prevention of cardiovascular disease and stroke from 2000 to 20003.

The model consisted of five categories of improvement strategies. First, prioritize performance, for example, accept a clinical practice guideline, establish project leaders, and use PPRNet practice reports to guide improvement. Second, involve all staff, for example, train staff on guidelines and practice improvement objectives, arrange clinical information loops to doctors from staff, extend staff roles in care delivery, and minimize staff turnover. Third, redesign delivery systems, for example, schedule lab work before office visits, use point-of-care tests, and assign routine monitoring to nursing staff. Fourth, activate patients via office posters and practice newsletters and provide incentives to meet guidelines such as discounted screening.

Finally, the model involved use of electronic medical record tools such as internal messaging or flags for team coordination, queries to flag charts for patients needing specific care, and queries and automated letter generation for outreach. The project's 10 intervention practices used more of the model items than the 9 control practices (69 vs. 48 percent), as did high-performing practices versus mid-range or low performers (81 vs. 39 vs. 46 percent). Chris Feifer, Dr.P.H., of the University of Southern California, and Steven Ornstein, M.D., of the Medical University of South Carolina, conclude that the PPRNet-TRIP Improvement Model might help small practices translate research into practice and improve care outcomes.

See "Strategies for increasing adherence to clinical guidelines and improving patient outcomes in small primary care practices," by Drs. Feifer and Ornstein, in the August 2004 Joint Commission Journal on Quality and Safety 30(8), pp. 431-441.

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