Study of Bordley Margolis Stuart Lannon and Keyes

Study of Bordley, Margolis, Stuart, Lannon and Keyes (2001) What is the organizational affiliation of the All are affiliated with the University of North Carolina (UNC) at Chapel Hill. Drs. Bordley, Margolis and Lannon and Ms. Stuart work at the Children’s Primary Care Research Group, Department of Pediatrics of UNC. Dr. Keyes is at the UNC’s Frank Porter Graham Center for Child Development.
What was the setting for this research study? The setting for the research study is a group of eight practices, enrolling at least 5 newborns each month, located in Durham, North Carolina, identified in the study as the “1 community” and with a population of 182,000.
Who were the participants? Participating in the study were physicians, nurses, and clerical staff working in eight practices: 2 family practice group practices, 3 pediatric group practices, the pediatric department of a large HMO, a university medical center, and a federally qualified community health center in the specified research study setting. All are identified in the study.
What was the purpose of study and what were the outcomes of interest? List the outcomes and describe how they were measured. The purpose of the study was to determine whether a group of primary care practices in 1 community could significantly improve their delivery of childhood preventive services by implementing an office-based quality improvement system, which breaks targeted services down into their component steps and focuses on improving processes involving the interactions of patients, staff, and providers to ensure that each step is performed on every eligible patient at every encounter. The study aimed at finding out whether an office-systems approach, which proved effective in a previous study in a larger community-wide intervention, would work in a pediatric primary care setting where delivery rates are lower than national goals and providers’ estimates. The research study focused on two sets of outcomes: process outcomes and preventive service outcomes. Process outcomes refer to the office systems developed and adopted at each practice and measured according to complexity and frequency of use. Surveys were used to collect baseline information on existing office systems prior to developing and adopting new office systems. During implementation, the project staff used structured observation, chart reviews, and informal “drop-in” visits to assess the extent to which new systems were actually used. Tables 1, 2 and 3 show the findings.
Preventive service outcomes were the study’s primary outcomes and refer to the proportions of children up-to-date on immunizations at 12, 19, and 24 months and the proportions screened for anemia, TB, and lead exposure. Baseline data was gathered by auditing 40 randomly selected practice charts of 24 to 36-month old patients in each practice. These were then compared with follow-up data by auditing a second random sample of charts 12 months after each office’s systems were operational. The trends were statistically analyzed, graphed, and interpreted.
What did the researchers do (interventions)? Researchers assisted the eight practices by involving office staff at all levels in assessing and developing office-based quality improvement systems for prevention, adapting the principles of continuous quality improvement, adult learning theory, and academic detailing. The researchers conducted visits and feedback sessions to push practice change, form and monitor working groups, review performance data and gaps, develop and implement solutions, monitor improvements and revise interventions as needed. Table 1 of the study summarizes each working group’s analysis of their office’s delivery system.
Describe the results in relation to the outcomes. The researchers found that implementing office-based quality improvement systems to improve the delivery of preventive services (process outcomes) seemed to be both feasible and effective, as shown in the increases in the overall rates of immunization coverage and rates of screening for anemia and lead exposure (preventive service outcomes). The researchers pointed out many limitations for further study.
Reference List
Bordley, W.C., Margolis, P.A., Stuart, J., Lannon, C. and Keyes, L. (2001) Improving preventive service delivery through office systems. Pediatrics 108 (3), p. e41. Available 19 May 2009 from: http://pediatrics.aappublications.org/cgi/content/full/108/3/e41#B6