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Increasing Screening and Interventions for Four Unhealthy Behaviors. Jim Mold, M.D., M.P.H. Dept. of Family and Preventive Medicine OUHSC, OKC. Jim Mold Cheryl Aspy Zsolt Nagykaldi Millisa Ellefson Eileen Merchen Cara Vaught Katy Smith. Mike Aaron Sharad Swami Tamara Hartsell
Jim Mold, M.D., M.P.H.
Dept. of Family and Preventive Medicine
The Robert Wood Johnson Foundation
Project Period 7/1/2005 – 9/30/2007
Will a multi-component translational strategy result in the consistent and sustainable delivery of effective screening, very brief interventions, and counseling for improving diet, increasing exercise, and reducing cigarette and alcohol use among patients 14 years old and older being seen in primary care practices.Research Question
Screening: Addition of evidence-based screening questions to the vital signs process
Very Brief Interventions: Referral to a community-based resource or provision of written educational material
Brief Counseling: 5 - 15 minute evidence-based counseling provided by the clinician
Chart Audit and Feedback: Chart audits Q1month to document proportion of patients screened and proportion receiving interventions
Training Modules: Three evidence-based training sessions (five modules) for clinicians and staff
Practice Facilitation: Coordination of QI activities and assistance with obstacles (e.g. form/template redesign; identification of community resources, etc.) by PEA
Quality Circles: Q2month lunch meetings during which geographical clusters of practices met to review progress, address problems, and share successes
PI Visits: Q6month visits by PI during patient care activities to observe and ask questions about the processes, answer questions, and make suggestions.
Training time was reimbursed and evidence-based (double) CME was awarded.
PLAN: Small change proposed
DO: Trial in a small number of patient encounters
STUDY: Documentation of what happened
ACT: Decision regarding what to do next (expand, abandon, modify)
Interventions were introduced in 6-month cycles, each group of practices adding different interventions each cycle.
Chart audits: 75 randomly-selected records; screening, VBI, BC at that visit
Patient surveys (pre-office visit and 1-month later via mail): patients recruited/enrolled by practice facilitator in practices’ waiting rooms; f/u surveys mailed by project manager
Practice facilitator diaries
Field notes from quality circle meetings
PI and Co-PI notes
1. W. Oklahoma (Clinton/Weatherford)
2. Central Oklahoma (OKC)
3. E. Oklahoma (Grove)
(Per 1000 patient encounters estimate)
Screening (1000): $200
Very brief interventions (400): $ 80
Brief counseling (50): $830
(Per Cluster Estimate)
Project management: $2,080
Training and CME:
Trainers: $ 450
Practice facilitation: $6,750
Quality circles: $ 900
PI visits: $2,700
Travel and food: $8,000