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Health Research Policy and Systems
Published in: Health Research Policy and Systems 1/2015

Open Access 01-12-2016 | Study Protocol

Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care

Authors: Andrew Quanbeck, Randall T Brown, Aleksandra E Zgierska, Roberta A Johnson, James M Robinson, Nora Jacobson

Published in: Health Research Policy and Systems | Issue 1/2015

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Abstract

Background

Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy – systems consultation –intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy – translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches (‘systems consultants’) to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction.

Methods/Design

The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for ‘fully developed use’ of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis.

Discussion

The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.
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Metadata
Title
Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care
Authors
Andrew Quanbeck
Randall T Brown
Aleksandra E Zgierska
Roberta A Johnson
James M Robinson
Nora Jacobson
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Health Research Policy and Systems / Issue 1/2015
Electronic ISSN: 1478-4505
DOI
https://doi.org/10.1186/s12961-016-0079-2

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