Paper
Saturday, 22 July 2006
This presentation is part of : Implementing Evidence-Based Nursing
Implementing Change in Primary Care
Lynne S. Nemeth, PhD, RN, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
Learning Objective #1: Describe the innovative strategies that are used by primary care practices to implement clinical guidelines for cardiovascular disease prevention and treatment, using electronic records.
Learning Objective #2: Relate the important concepts of a conceptual framework designed to guide practice improvement and change in primary care.
Context: Major gaps exist related to the availability of clinical evidence, best practices, measures and performance in health care. Evidence-based guidelines and electronic medical record (EMR) tools provide tremendous potential for improving the quality of care. The impact of these tools is highly variable, related to differences in their implementation and unique characteristics of the practice setting. Objective: The purpose of this research was to explore the process of change used to implement clinical guidelines in primary care practices using electronic medical records. The goal was to generate a conceptual framework for implementing change in primary care practices. Design: Mixed methods qualitative study developed within a practice based primary care research network. Setting: Eight community-based primary care practices in seven states were intervention sites in the Practice Partner Research Network -Translating Research into Practice (PPRNet-TRIP II) pragmatic clinical trial, "Primary and Secondary Prevention of Cardiovascular Disease and Stroke". Participants: A maximum variation, purposive sample of practice members from each of the eight intervention sites were selected for in-depth interviews. Sample included physicians, midlevel providers, nurses, other clinical staff, office staff and managers. Instrument: Field notes recording observations from periodic site visits per site provided context for in-depth interviews. Interviews were adapted from the Microsystems in Healthcare study. Evaluation data from the TRIP-II study and organizational cultural characteristics measured through the Practice Staff Questionnaire provided additional descriptive data to enrich the case studies.  Results: Case descriptions illustrated variations in the change process and practice based ratings regarding perceptions of organizational culture. The conceptual framework “How to Lead Change for PPRNet-TRIP” illustrates the characteristics of the process of change. Conclusions: Practices that develop clear goals, involve and develop their teams, refine systems and use performance data are successful in improvement and change.

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