Conducting a randomized controlled trial of CQI and academic detailing to implement clinical guidelines

The Joint Commission Journal on Quality Improvement
C R HorowitzA D Cheadle

Abstract

A multisite, randomized controlled trial was conducted from August 1994 through January 1996 to compare the impact of two strategies-academic detailing (AD) and continuous quality improvement (CQI) teams-on the implementation of national guidelines for the primary care of hypertension and depression. Twelve small groups of providers at four clinics-two at Group Health Cooperative of Puget Sound (Seattle) and two at academic medical centers-were randomized in blocks along with their primary care patients to receive AD alone, AD plus CQI, or usual care. A detailing session conducted by a physician and two follow-up sessions conducted by a pharmacist lasted an average of 8-9 minutes. Each CQI team, which met, on average, 14 times in nine months, devised at least one intervention (for example, weight loss counseling for hypertensives by nurse practitioners). The detailing endeavors differed greatly across organizations. Although all teams generally worked well together, organizational factors such as staff layoffs and reorganizations competed for the teams' attention. Team leaders differed in their ability to inspire members to "run with" ideas and to motivate personnel outside the team to implement interventions. Surveys and semi-...Continue Reading

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Citations

Jan 30, 2004·Journal of General Internal Medicine·Eric B LarsonUNKNOWN Task Force on the Domain of General Internal Medicine. Society of General Internal Medicine (SGIM)
Mar 17, 2004·Journal of Drug Education·Julie A HoganMichael Klitzner
Apr 29, 2009·Administration and Policy in Mental Health·J Curtis McMillenVictoria A Osborne
Jan 22, 2003·Journal of General Internal Medicine·Susan C HedrickWayne Katon
May 12, 2006·Medical Care Research and Review : MCRR·Bryan J WeinerMark Becker
Jul 14, 2006·Journal of General Internal Medicine·Lisa V RubensteinMartin L Lee
Jun 15, 2012·The Cochrane Database of Systematic Reviews·Noah IversAndrew D Oxman
Sep 19, 2002·Health Services Research·Lisa V RubensteinNancy P Gordon

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