1. Practice-based Research Networks’ Role in Implementing Practice Change
Cornelius Thiels, MSIII
Deborah Graham, MSPH
KCUMB, College of Osteopathic Medicine
AAFP National Research Network
Kansas City, MO
Leawood, KS

2. Contributors Susan Bertram, MSN, Olmsted Medical Center, Rochester, MN
Perry Dickinson, MD, University of Colorado - Denver
Jessica Huff, MS, University of Colorado - Denver
Marge Kurland, RN, Olmsted Medical Center, Rochester, MN
Angela Lanigan, MA, AAFP National Research Network, Leawood, KS
Deborah Main, PhD, University of Colorado - Denver
Janet Ann McAndrews, MPH, American Academy of Family Physicians, Leawood, KS
Donald Nease, MD, University of Colorado - Denver
Paul Nutting, MD, MSPH, Center of Research Strategies, Denver, CO
Wilson Pace, MD, AAFP National Research Network, Leawood KS
Elizabeth Stewart, PhD, AAFP National Research Network, Leawood, KS
Barbara Yawn, MD, Olmsted Medical Center, Rochester, MN

3. Session Goals Discuss PBRNs and integrating change in practice
Discuss how participating in practice-based research studies facilitated implementation of change
Discuss the techniques used to implement change

4. Practice-Based Research Networks
A group of ambulatory practices devoted principally to primary care.
Typically, PBRNs draw on the experience and insight of practicing clinicians to identify and frame research questions whose answers can improve the practice of primary care.
The PBRN can produce research findings that are immediately relevant to the clinician.

5. How do PBRNs help practices integrate research changes into practice?
Help translate research results into practice
Help practices recognize importance of tools and systematic approaches to care
Teach practices to implement change on their own
Help practices learn how to leverage change processes into clinical care
Help practices create long-term sustainable change in their approaches to clinical care

6. Practice-based Research Networks
“Give a man a fish and you feed him for a day.”

7. Practice-based Research Networks
“Teach a man to fish and you feed him for a lifetime.”

8. Implementing Change Three PBRN Studies Depression
Postpartum Depression
Healthy Interventions
-Look at three studies and how practices implemented change
-We are going to show how these studies didn’t just create change during the study (blue), or change that slowly resolved (red), but change that is sustainable even after the project is done (green)

9. Implementing Change Three PBRN Studies Depression
Postpartum Depression
Healthy Interventions

10. Depression Study 18 month study Background
Teach practices how to implement and sustain fundamental changes in their delivery systems
Context of improving depression care
18 month study
Sustainability 2 years after the study ended

11. Depression Study Methodology
18 family medicine and internal medicine practices
3 weekend collaborative learning sessions
Implemented change between sessions
Material covered both change processes and clinical learning

12. Depression Study Techniques for implementing change
Practice Level Improvement Team (IT)
Reflection Action Process (RAP)
-Explain IT
-Explain RAP

13. Depression Study a. Practice Level Improvement Team (IT) What Worked?
Team diversity
Starting IT early
Consistent meetings
Involvement of physician champion

14. Depression Study b. Reflection Action Process (RAP)
Relationship between sustained RAP and sustained tracking/case management

15. Implementing Change Three PBRN Studies Depression
Postpartum Depression
Healthy Interventions

16. Postpartum Depression Study
Background
Parent Study: Translating Research into Practice for Postpartum Depression (TRPPD).
Evaluation of implementation of PPD screening, diagnosis, follow-up, and management program in primary care clinics

17. Postpartum Depression Study
Methodology
32 family medicine practices nationwide
Randomized to intervention or delayed intervention groups
Intervention was the implementation of practice-wide program for screening, diagnosing, follow-up, and managing postpartum depression
Extensive training and facilitation by central team

18. Postpartum Depression Study
Secondary study
Mid-point semi-structured telephone interviews
Lead physician and study coordinator from 28 primary care practices participating in large clinical trial
Questions around impact on practice of participating in PBRN study

19. Postpartum Depression Study
6 Major Themes
Participation led to:
Recognition of importance of tools and systematic approach
More effective teamwork and communication
Extension of the study tools and systematic approach to other chronic conditions
Increased professional self-worth and community recognition
Opportunity and support for staff members to “stretch” into new roles
Increased research literacy within the practice

20. Implementing Change Three PBRN Studies Depression
Postpartum Depression
Healthy Interventions

21. Healthy Interventions Study
Background
Parent Study: Americans in Motion—Healthy Interventions (AIM-HI)
Goals
To encourage primary care clinicians and staff to be fitness role models to patients
To improve clinician’s & practice’s ability to positively affect the fitness of patients
To enhance awareness of practice’s unique ability to promote fitness within their communities
Practices randomized into 2 groups:
“Traditional Office”
“Healthy Office”

22. Healthy Interventions Study
Methods
Traditional Office received training/materials to implement AIM-HI concepts with patients
Healthy Office received training for patients, but were also encouraged to use the tools and strategies within the office in order to create a work culture of wellness.
No real control group

23. Healthy Interventions Study
Results
A non-prescriptive lifestyle behavioral change intervention, AIM-HI, focused on a small changes philosophy and motivating patients to find their own solutions to unhealthy behaviors.
Intervention resulted in clinically significant improvements in weight, physical fitness, and emotional well being for over 20% of the population .

24. Successful Techniques for Facilitating Sustainable Change
Practice Improvement Teams
Reflection Action Process (RAP)
Employee wellness teams
Long-distance facilitation

25. What this means for YOU Making sustainable change is difficult
PBRNs can help practices implement change
These changes can go beyond the scope of the study
PBRNs can facilitate long-term change that are sustainable even after the study has ended

26. Questions?
Cornelius Thiels, MSIII Kansas City University of Medicine and Biosciences Kansas City, MO Deborah Graham, MSPH AAFP National Research Network Leawood, KS ext 3176