Practice-based Research Networks’ Role in Implementing Practice Change Cornelius Thiels, MSIII Deborah Graham, MSPH KCUMB, College of Osteopathic Medicine AAFP National Research Network Kansas City, MO Leawood, KS

Contributors Susan Bertram, MSN, Olmsted Medical Center, Rochester, MN Perry Dickinson, MD, University of Colorado - Denver Jessica Huff, MS, University of Colorado - Denver Marge Kurland, RN, Olmsted Medical Center, Rochester, MN Angela Lanigan, MA, AAFP National Research Network, Leawood, KS Deborah Main, PhD, University of Colorado - Denver Janet Ann McAndrews, MPH, American Academy of Family Physicians, Leawood, KS Donald Nease, MD, University of Colorado - Denver Paul Nutting, MD, MSPH, Center of Research Strategies, Denver, CO Wilson Pace, MD, AAFP National Research Network, Leawood KS Elizabeth Stewart, PhD, AAFP National Research Network, Leawood, KS Barbara Yawn, MD, Olmsted Medical Center, Rochester, MN

Session Goals Discuss PBRNs and integrating change in practice Discuss how participating in practice-based research studies facilitated implementation of change Discuss the techniques used to implement change

Practice-Based Research Networks A group of ambulatory practices devoted principally to primary care. Typically, PBRNs draw on the experience and insight of practicing clinicians to identify and frame research questions whose answers can improve the practice of primary care. The PBRN can produce research findings that are immediately relevant to the clinician.

How do PBRNs help practices integrate research changes into practice? Help translate research results into practice Help practices recognize importance of tools and systematic approaches to care Teach practices to implement change on their own Help practices learn how to leverage change processes into clinical care Help practices create long-term sustainable change in their approaches to clinical care

Practice-based Research Networks “Give a man a fish and you feed him for a day.”

Practice-based Research Networks “Teach a man to fish and you feed him for a lifetime.”

Implementing Change Three PBRN Studies Depression Postpartum Depression Healthy Interventions -Look at three studies and how practices implemented change -We are going to show how these studies didn’t just create change during the study (blue), or change that slowly resolved (red), but change that is sustainable even after the project is done (green)

Implementing Change Three PBRN Studies Depression Postpartum Depression Healthy Interventions

Depression Study 18 month study Background Teach practices how to implement and sustain fundamental changes in their delivery systems Context of improving depression care 18 month study Sustainability 2 years after the study ended

Depression Study Methodology 18 family medicine and internal medicine practices 3 weekend collaborative learning sessions Implemented change between sessions Material covered both change processes and clinical learning

Depression Study Techniques for implementing change Practice Level Improvement Team (IT) Reflection Action Process (RAP) -Explain IT -Explain RAP

Depression Study a. Practice Level Improvement Team (IT) What Worked? Team diversity Starting IT early Consistent meetings Involvement of physician champion

Depression Study b. Reflection Action Process (RAP) Relationship between sustained RAP and sustained tracking/case management

Implementing Change Three PBRN Studies Depression Postpartum Depression Healthy Interventions

Postpartum Depression Study Background Parent Study: Translating Research into Practice for Postpartum Depression (TRPPD). Evaluation of implementation of PPD screening, diagnosis, follow-up, and management program in primary care clinics

Postpartum Depression Study Methodology 32 family medicine practices nationwide Randomized to intervention or delayed intervention groups Intervention was the implementation of practice-wide program for screening, diagnosing, follow-up, and managing postpartum depression Extensive training and facilitation by central team

Postpartum Depression Study Secondary study Mid-point semi-structured telephone interviews Lead physician and study coordinator from 28 primary care practices participating in large clinical trial Questions around impact on practice of participating in PBRN study

Postpartum Depression Study 6 Major Themes Participation led to: Recognition of importance of tools and systematic approach More effective teamwork and communication Extension of the study tools and systematic approach to other chronic conditions Increased professional self-worth and community recognition Opportunity and support for staff members to “stretch” into new roles Increased research literacy within the practice

Implementing Change Three PBRN Studies Depression Postpartum Depression Healthy Interventions

Healthy Interventions Study Background Parent Study: Americans in Motion—Healthy Interventions (AIM-HI) Goals To encourage primary care clinicians and staff to be fitness role models to patients To improve clinician’s & practice’s ability to positively affect the fitness of patients To enhance awareness of practice’s unique ability to promote fitness within their communities Practices randomized into 2 groups: “Traditional Office” “Healthy Office”

Healthy Interventions Study Methods Traditional Office received training/materials to implement AIM-HI concepts with patients Healthy Office received training for patients, but were also encouraged to use the tools and strategies within the office in order to create a work culture of wellness. No real control group

Healthy Interventions Study Results A non-prescriptive lifestyle behavioral change intervention, AIM-HI, focused on a small changes philosophy and motivating patients to find their own solutions to unhealthy behaviors. Intervention resulted in clinically significant improvements in weight, physical fitness, and emotional well being for over 20% of the population .

Successful Techniques for Facilitating Sustainable Change Practice Improvement Teams Reflection Action Process (RAP) Employee wellness teams Long-distance facilitation

What this means for YOU Making sustainable change is difficult PBRNs can help practices implement change These changes can go beyond the scope of the study PBRNs can facilitate long-term change that are sustainable even after the study has ended

Questions? Cornelius Thiels, MSIII Kansas City University of Medicine and Biosciences Kansas City, MO cthiels@kcumb.edu 404.219.6081 Deborah Graham, MSPH AAFP National Research Network Leawood, KS dgraham@aafp.org 913.906.6000 ext 3176