Project Summary
Changing the behavior of health providers can be challenging, and significant gaps exist in our knowledge of how to best spread or disseminate new medical evidence into everyday practice. This is true when the evidence involves a new patient-centered care method such as shared decision making (SDM). The most common dissemination methods used are journal publications, presentations, and educational material that often fails to produce timely or sustainable practice level changes. A unique partnership between a Medicaid network and a well-established group research network provides an ideal venue to examine the effectiveness of new effective methods of dissemination. We previously developed an asthma toolkit that was tested across a regional network of pediatric, family medicine, and internal medicine healthcare practices in Mecklenburg County, North Carolina. During this study, key principles of community-based participatory research were used to engage providers and patients to develop a Facilitator-Led participant OWned (FLOW) approach to dissemination. The FLOW approach uses practice facilitators to guide practices through the process of adapting the toolkit into the existing culture and workflow. This approach led to rapid dissemination and sustainability of the toolkit across six practices. The initial results have shown marked improvement in patient outcomes (including increased adherence to taking medications that control asthma and decreased disease complications) with increased patient involvement in the creation of the care plans.
Objectives: The objective is to determine what dissemination strategy most effectively increases practice level adoption of shared decision making, improves patient outcomes, and increases patient involvement in care decisions.
Methods: Here we will leverage a partnership between the statewide Medicaid network and NCNC, a statewide consortium of research networks, to identify best practices for dissemination of the shared decision-making toolkit. We will test the FLOW method for dissemination on a larger scale by randomizing 30 primary care practices from four practice-based research networks to one of three dissemination arms: (1) FLOW approach to dissemination; (2) traditional dissemination with facilitator exposure; and (3) passive dissemination.
Patient Outcomes (Projected): The primary outcome will be patient perceptions of involvement in their care, measured using a patient survey and qualitative data collection. Secondary outcome measures will be: asthma complications (defined by ED, hospital utilization, and medicine given during asthma complications) and adherence to medication that controls asthma, measured by pharmacy refill rates. This study will provide crucial data to support a novel method for dissemination of a new paradigm of care delivery into primary care practices.
Tapp H, Derkowski D, Calvert M, Welch M, Spencer S. Patient perspectives on engagement in shared decision-making for asthma care. Fam Pract. 2016 Dec 29. pii: cmw122. doi: 10.1093/fampra/cmw122. [Epub ahead of print] PubMed PMID: 28034918.
Comparing Traditional and Participatory Dissemination of a Shared Decision Making Intervention (ADAPT-NC): a Cluster Randomized Trial
Hazel Tapp, Andrew McWilliams et al., "Comparing Traditional and Participatory Dissemination of a Shared Decision Making Intervention (ADAPT-NC): a Cluster Randomized Trial," European Journal of Medical Research 9 (October 2014): 158.
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