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© 2016 Quanbeck et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver () applies to the data made available in this article, unless otherwise stated. Quanbeck et al. Health Research Policy and Systems (2016) 14:8 DOI 10.1186/s12961-016-0079-2
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Background Context This project addresses the urgent need to promote the adoption of evidence-based practices (EBPs) in healthcare by pilot-testing an innovative implementation strategy named the Systems Consultation Strategy (SCS). The SCS is based on an evidence-based quality improvement approach with roots in systems engineering. This ap- proach, named NIATx (the Network for the Improvement of Addiction Treatment) [1-3], has been widely tested in addiction treatment. The SCS extends elements of the NIATx approach to reducing variation in opioid prescrib- ing in primary care. The proposed approach is intended to be a generalizable approach to EBP adoption, used in this proposal for a specific problem (opioid prescribing prac- tices) and setting (primary care). The standard approach to improving medical practice includes developing and disseminating clinical guide- lines. Developing the guidelines involves panels of ex- perts systematically reviewing the literature, achieving consensus, and publishing the results in a medical jour- nal intended for the clinical audience [4]; this approach leaves a great gap between clinical knowledge and clin- ical practice [5-8]. Various approaches have been tried to narrow this gap, such as providing educational materials, audit/feedback [9], and academic detailing [10], with mixed success; about 30 40% of patients do not receive evidence-based care, and about 20 25% of care given is unnecessary or potentially harmful [8, 11]. Clinicians tend to continue to do what is comfortable, and value personal experience and familiar practice routines over scientific evidence [12]. Rationale for proposed pilot study This protocol was funded under the United States National Institute of Health s R34 funding mechanism, the purpose of which is to provide support for the initial development of a clinical trial or research project . In this case, the funding will support a pilot study of the SCS to prepare for a large randomized control trial that will test the SCS against alternative approaches to EBP adoption in primary care. The SCS (1) teams clinical guideline writers with implementation specialists and primary care physicians to translate guidelines into a checklist-based implementation guide; (2) selects, trains, and deploys physician peer coaches (systems consul- tants) to help primary care clinicians implement EBPs using evidence-based tools of systems engineering; and
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