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BACKGROUND/RATIONALE:
Methodological problems and lack of details make it difficult to determine from the published evidence what organizational strategies work best to improve chronic illness care. Difficulties in accessing relevant research in bibliographic and grant databases further impede efforts to use research evidence.
OBJECTIVE(S):
Overall Goal: to systematically identify, track and synthesize research on organizational strategies for implementing medical evidence in clinical practice. Objective 1: conduct a systematic review of research evidence to identify effective organizational interventions to implement clinical evidence for high prevalence, high priority chronic illnesses of most relevance to the VA [SYNergi]. Objective 2: create and maintain a free access database (GUIDE) which will include the abstracts from the systematic review plus abstracts of currently funded research in progress in order to prospectively track new research regarding organizational intervention to implement clinical evidence.
METHODS:
Systematic review of published and in progress research of interventions that explicitly target structures or processes at either the macro or micro-organizational level. We modified the taxonomy of interventions used by the EPOC and mapped onto Wagner’s Chronic Care Model for coding. We developed a highly sensitive systematic search strategy that is generalizable to QUERI diseases and COPD using disease-specific terms. Methods include 1) a detailed, iterative group process to develop explicit disease-specific inclusion and exclusion criteria and 2) a detailed electronic form to abstract data.
FINDINGS/RESULTS:
SynERGI: Searches updated through 12/29/06 and identified a total of 19,588 potentially relevant citations. Completed study eligibility determinations for each of the following VA-relevant diseases are: DM (total citations 6506->51 eligible studies); COPD (1366->10); IHD (3511-> 12); CHF (1756->31); colorectal cancer (1047->none); mental disorders (2424->19); SUD (1352->9); SCI (249->none); HIV (1364->3). Preliminary findings suggest that interventions using elements of complex adaptive systems theory are more successful in moving evidence into practice. Guide: A revised search was conducted in 2005 based upon new mandatory trial registries. A final search was implemented to identify all potentially eligible studies in progress at anytime during the first 6 months of 2006 (in light of the ICMJE 3/06 and 6/06 deadlines for clinical trial registrations 3/06 and 6/06). Initial screenings have been completed on the following diseases: DM (1182 records), COPD (266), colorectal CA (702), CHF (215), HIV (2314), SUD (710), depression (721), SMI (728), SCI (120), and IHD (888). One hundred and sixty-seven unique studies have been identified as potentially eligible. Secondary screenings are in progress to confirm final eligibility and abstract study data into GUIDE database.
IMPACT:
Results and products will allow researchers and clinicians to more easily identify innovative cutting-edge organizational research to improve healthcare and inform QUERI and QI efforts within the VA.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care, Technology Development and Assessment
Keywords:
Clinical practice guidelines
MeSH Terms:
none
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