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HSR&D 2004 National Meeting Abstracts

2068. Targeted Interventions to Implement IHD Clinical Practice Guidelines
Gail M Powell-Cope, PhD, HSR&D, Florida Sunshine Veterans Integrated Service Network, J Beckstead, USF College Research Center, S Luther, Patient Safety Research Center, B Neugaard, NFSG, E Pracht, USF College of Public Health, R Swisher, WPB VAMC, J Vara, Miami VAMC, R Zoble, Tampa VAMC, A Nelson, Tampa VAMC

Objectives: Research has shown that multiple intervention strategies are generally effective in promoting clinician adherence to clinical practice guidelines, however the conditions under which strategies are most effective are unclear. The specific objective of this study was to describe the temporal aspect of guideline adherence over three periods of time: pre-implementation, post-implementation of general strategies, and post- implementation of barrier-targeted strategies.

Methods: This one-year randomized controlled trial was conducted in six VAMCs. Interventions sites received an educational outreach intervention for providers and a patient education intervention tailored to overcome identified barriers to implementation. Data were collected through chart reviews to identify guideline adherence for aspirin, beta-blockers, ace inhibitors and lipid lowering agents. Hypotheses were tested with extended logistic regression analyses, controlling for patient-level covariates.

Results: ·Compared to cases observed in a baseline period prior to the implementation of the IHD guideline, the probability that a patient received any of the medications did not increase in the period following general implementation. ·Facilities receiving targeted interventions showed increased adherence to beta-blockers compared to the period following the general implementation. ·Facilities receiving targeted interventions did not show increased adherence for any medication compared to facilities that did not.

Conclusions: In this trial, targeted implementation strategies were effective only partially for adherence to beta-blockers. Variations in implementation of the intervention across sites likely reduced its effectiveness.

Impact: While local customization of implementation of evidence-based practice is widely advocated, is usefulness may be limited when there is a VA-wide secular trend for adhering to a guideline.