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Implementation of the Asthma Practice Guideline in the Army Medical Department

Implementation of the Asthma Practice Guideline in the Army Medical Department: Evaluation of Process and Effects

Donna O. Farley
Shan Cretin
Georges Vernez
Suzanne Pieklik
Elaine Quiter
J. Scott Ashwood
Wenli Tu
Copyright Date: 2005
Edition: 1
Published by: RAND Corporation
Pages: 210
  • Book Info
    Implementation of the Asthma Practice Guideline in the Army Medical Department
    Book Description:

    In partnership with the Army Medical Department, RAND worked to implement clinical practice guidelines. This report evaluates the asthma guideline demonstration. It documents the actions, assesses effects, and measures the quality and limitations of data for monitoring outcomes. The authors found that the implementation scored successes but resource limitations and organizational barriers curbed progress. They conclude that flexibility, monitoring, and training are the keys to implementing the guidelines. They also found that patient education needed improvement.

    eISBN: 978-0-8330-4073-2
    Subjects: Management & Organizational Behavior, Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xiv)
  6. Summary
    (pp. xv-xxx)
  7. Acknowledgments
    (pp. xxxi-xxxii)
  8. Abbreviations
    (pp. xxxiii-xxxiv)
  9. CHAPTER ONE Introduction
    (pp. 1-16)

    The Army Medical Department (AMEDD) has made a commitment to establishing a structure and process to support its military treatment facilities (MTFs) in implementing evidence-based practice guidelines to achieve best practices that reduce variation and enhance quality of medical care. With the goal of establishing such a system, the AMEDD contracted with RAND to work as a partner in the development and testing of guideline implementation methods for ultimate application to an Army-wide guideline program.

    The AMEDD-RAND project fielded three sequential demonstrations over a two-year period, in each of which participating MTFs implemented a different clinical practice guideline. This approach...

  10. CHAPTER TWO Methods and Data
    (pp. 17-34)

    The RAND evaluation for the asthma guideline demonstration gathered information about both the processes of implementing the practice guideline at participating MTFs and the effects of these implementation activities on delivery of care for asthma patients. In this chapter, we summarize the methods and data for these two evaluation components. Additional details about methodology are provided in Appendix B.

    Implementation of a clinical practice guideline is one type of quality improvement intervention. An evaluation of any quality improvement intervention should recognize the incremental nature of these processes, which require time to achieve lasting improvements. A comprehensive evaluation of guideline implementation,...

  11. CHAPTER THREE Asthma Populations and Practices at the Baseline
    (pp. 35-52)

    An understanding of the patient population and baseline performance for key care measures is critical for designing guideline implementation strategies by the demonstration MTFs and evaluating the impact of their implementation of those strategies.

    Asthma patients need ongoing care management. Therefore, TRICARE beneficiaries with asthma are regular users of services covered by their TRICARE benefits. These services may be provided by MTFs or network providers, depending on the patients’ TRICARE Prime enrollment status and the availability of needed services at the MTFs. As discussed earlier, each MTF serves asthma patients who are enrolled in TRICARE Prime at the MTF as...

  12. CHAPTER FOUR The Guideline Implementation Process
    (pp. 53-84)

    The asthma guideline demonstration was the second of the three demonstrations that tested an implementation approach that coordinated actions at the command (MEDCOM) and local (MTF) levels to achieve best clinical practices. MEDCOM defined the desired clinical practices (as specified in the DoD/VA practice guideline) and key metrics to measure attainment of those practices; provided tools to assist the MTFs as they introduced new practices in response to the guideline; and facilitated MTF guideline implementation via site visits, e-mail, and phone communications.

    The practice changes were carried out by the MTFs as the health-care delivery organizations. The MTFs were offered...

  13. CHAPTER FIVE Effects of Guideline Implementation
    (pp. 85-108)

    In this chapter, we examine the extent to which introduction of the asthma guideline at the four demonstration MTFs changed clinical practices at those facilities. We use information from the process evaluation to assess how well providers at the demonstration sites appeared to understand and accept the guideline. We also summarize reports from the sites on their monitoring of the effects of implementation activities on clinical practices. We then report results from our analysis of encounter data on trends in clinical practices for the indicators of asthma care, comparing the demonstration sites to control sites that had not used the...

  14. CHAPTER SIX Synthesis of Findings from the Demonstration
    (pp. 109-122)

    In this chapter, we synthesize the factors influencing the successes and limitations of the asthma guideline demonstration. We begin by discussing the implications of our findings regarding the implementation process, including an evaluation of how well the demonstration performed on the six critical success factors presented in Chapter One of this report. Next we discuss the implications of our analysis of the effects of the asthma guideline implementation on the clinical practice indicators. We will also discuss the implications of our cost analysis. Then we will describe data issues that emerged from the demonstration that are likely to affect other...

  15. APPENDIX A Hypotheses for Effects of Improved Asthma Care Practices
    (pp. 123-124)
  16. APPENDIX B Evaluation Methodology
    (pp. 125-152)
  17. APPENDIX C Modules of the Climate Survey
    (pp. 153-160)
  18. APPENDIX D Physician Questionnaire
    (pp. 161-168)
  19. APPENDIX E Analyses of Asthma Metrics
    (pp. 169-172)
  20. Bibliography
    (pp. 173-176)