We propose a cooperative agreement demonstration project aimed at improving the translation of prevention research into practice. While the benefits of many preventive services have been well documented in the peer reviewed literature, it has been difficult to integrate these services into practice. This problem is of no special importance to minority health since it is unlikely that treatment equalization alone will end racial disparities in health. The proposed project includes a randomized controlled trial. A new method for translating preventive research into practice-a nurse-mediated, single standard of practice model is currently being implemented within the Meharry Medical Practice Plan (MMPP). This model has been pilot tested at a Meharry affiliate. It was associated with substantial, sustained improvements in preventive services delivery. The present project represents a more formal test. To accomplish this test, physicians within the MMPP will be randomized to either the single standard model or the physician reminder model. We shall than enroll 890 participants, 445 from each group for two years, in order to measure the frequency with which preventive services are delivered. We shall also record demographic information; co-morbidity, knowledge, attitudes and beliefs pertinent to preventive services; medical history and family history; preventive services utilization; health service utilization; psychological status; social network size and social functioning; acute life events; locus of control; functional status; and satisfaction with care. Differences in outcomes between patients will be expressed as adjusted odds ratios of outcomes secondary to exposure to the single standard of care model as compared to the physician reminder model. The setting will comprise primary care clinics serving low-income, largely Medicaid- eligible populations. The project includes a partnership between researchers at two Historically Black Colleges and Universities (Meharry Medical College and Tennessee State University) and a health care practice. Depending on outcome, the objective of this partnership is to magnify and accelerate the priority areas identified in President Clinton's initiative to end racial and ethnic disparities in health, in particular, infant mortality, cardiovascular disease, cancer screening, HIV/AIDS, and adult and child immunizations. The project focuses on applied research, includes appropriate concurrent comparison groups, will identify key components of the model and organization conditions that result in successful implementation, and provides a test of how well the model transfers to a Medicaid setting.
| Gittner, LisaAnn S; Husaini, Baqar A; Hull, Pamela C et al. (2015) Use of Six Sigma for eliminating missed opportunities for prevention services. J Nurs Care Qual 30:254-60 |
