Numerical dynamic analysis of calcite twin lamellae in the Greenport Center Syncline

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ID: 305401
1974
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Abstract

PURPOSE

Guideline implementation in primary care has proven difficult. Although external assistance through performance feedback, academic detailing, practice facilitation (PF), and learning collaboratives seems to help, the best combination of interventions has not been determined.

METHODS

In a cluster randomized trial, we compared the independent and combined effectiveness of PF and local learning collaboratives (LLCs), combined with performance feedback and academic detailing, with performance feedback and academic detailing alone on implementation of the National Heart, Lung and Blood Institute's Asthma Guidelines. The study was conducted in 3 primary care practice-based research networks. Medical records of patients with asthma seen during pre- and postintervention periods were abstracted to determine adherence to 6 guideline recommendations. McNemar's test and multivariate modeling were used to evaluate the impact of the interventions.

RESULTS

Across 43 practices, 1,016 patients met inclusion criteria. Overall, adherence to all 6 recommendations increased (P ≤.002). Examination of improvement by study arm in unadjusted analyses showed that practices in the control arm significantly improved adherence to 2 of 6 recommendations, whereas practices in the PF arm improved in 3, practices in the LLCs improved in 4, and practices in the PF + LLC arm improved in 5 of 6 recommendations. In multivariate modeling, PF practices significantly improved assessment of asthma severity (odds ratio [OR] = 2.5, 95% CI, 1.7–3.8) and assessment of asthma level of control (OR = 2.3, 95% CI, 1.5–3.5) compared with control practices. Practices assigned to LLCs did not improve significantly more than control practices for any recommendation.

CONCLUSIONS

Addition of PF to performance feedback and academic detailing was helpful to practices attempting to improve adherence to asthma guidelines.
Reference Key
openalex_W1987492679 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors John H. Spang
Journal american journal of science
Year 1974
DOI
10.2475/ajs.274.9.1044
URL
https://doi.org/10.2475/ajs.274.9.1044
Keywords Keywords not found

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