Implementation of Evidence-Based Preventive Services Delivery Processes in Primary Care: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

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Figure 1.
Randomized trial comparing feedback and benchmarking to a multicomponent implementation intervention that also included academic detailing, practice facilitation, and IT support.

Table 1.

Characteristics of Practices and Clinicians at Baseline

Baseline Characteristics	Intervention (n)	Control (n)	P
Location^*
Rural	9	3
Suburban	2	5	.05
Urban	1	4
Size^†
Solo	5	7
2–4	5	2	.40
5+	2	3
Participating clinician's years in practice
1–10	3	7
11–20	3	2	.39
21–30	3	2
31–40	3	1
Clinician's autonomy^‡
Yes	11	8	.13
No	1	4
ACIC score (mean [SD])	4.41 (1.55)	5.81 (1.95)	.06
Perceived importance of preventive services^§
Immunizations	13.3 (4.7)	15.1 (1.9)	.22
Counseling	13.3 (2.0)	13.8 (2.6)	.61
Screening	14.2 (2.6)	13.3 (4.3)	.57

* Urban, population of >100,000; suburban, population of 25–100,000; rural, population of <25,000.
† Number of full-time equivalent clinicians in the practice.
‡ Clinician's ability to make independent decisions regarding how to organize his/her preventive care processes.
§ On a scale of 0–16, with higher scores indicating greater perceived importance.
ACIC, Assessment of Chronic Illness Care.

Table 2.

Primary Outcome Measures (Adoption of Evidence-Based Strategies)

Outcome	Intervention Group	Control Group	P^*
Improvements/opportunities
Total	20/38	4/23	.003
Adult	13/26	4/19	.05
Children	7/12	0/4	.042
Recall and reminders/opportunities
Total	6/8	1/4	.10
Adult	5/7	1/4	.14
Children	1/1	0/0	.16
Standing orders/opportunities
Total	9/14	1/8	.02
Adult	6/8	1/5	.05
Children	3/6	0/3	.13
Wellness visits/opportunities
Total	5/16	2/10	.53
Adult	2/11	2/10	.92
Children	3/5	0/0	.27
Clinicians improved/opportunities
Total	9/12	4/12	.06
Adult	8/12	4/12	.15
Children	5/11	0/7	.04

Table 3.

Changes in Rates of Delivery of Selected Preventive Services

Table 4.

Amount of Support and Measures of Improvement in Multi-Component Intervention Practices

Practice	PF	PEA Visits (n)	PEA Contact Time (min)	IT Visits (n)	Implementation/ Opportunities (n)	Processes Implemented (n)	Types of Improvements
1	A	20	125	4	3	3	SOc, WVc, WVa
2	A	25	385	5	3	2	RRa, SOa
3	A	9	195	3	2	0
4	B	42	2640	3	5	4	RRa, SOc, SOa, WVc
5	B	19	310	1	4	0
6	C	14	470	1	3	2	RRa, SOa
7	D	10	80	1	1	0
8	D	21	370	1	4	3	SOc, SOa, WVa
9	D/E	12	110	1	1	1	SOa
10	E	8	250	1	4	2	RRa, SOa
11	E	15	190	1	3	2	RRa, WVc
12	E	19	225	1	5	1	RRc
Medians		17	237	1	3	2

PF, practice facilitator (A-E represent 5 different facilitators); IT, information technology expert; Soc, standing orders for children; SOa, standing orders for adults; RRc, recall and reminders for children; RRa, recall and reminders for adults; WVc, wellness visits for children; WVa, wellness visits for adults.