Quanbeck et al health research policy and systems

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Quanbeck et al. Health Research Policy and Systems (2016) 14:8 Page 7 of 10
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We will apply a combination of directed and traditional content analysis [51] to answer the questions posed above. Our analysis will identify themes in the qualitative data and organize them into a conceptual model that incorpo- rates a priori elements of self-determination theory (e.g. relatedness, competence, autonomy) and diffusion of in- novations theory (e.g. homophily), while simultaneously seeking new insights inductively. Our second objective in this mixed methods compo- nent of our research is to assess fidelity to the interven- tion, defined as: (1) amount of the intervention received (i.e. dose ), (2) adherence to the protocol, and (3) quality of intervention delivery [52]. Assessing the dose of inter- vention received will rely on quantitative data (the num- ber of intervention hours delivered to clinic staff) obtained through logs kept by the systems consultants. For adherence, we will review the planned protocol with clinicians and document adaptations made to it at each site. To assess quality, we will examine both quantitative data on clinic-wide practices and focus group data on changes in clinicians prescribing attitudes and actions. Milestones and products of pilot test The primary goal of this project is to obtain pilot data for a large-scale clinical trial of different approaches to EBP adoption in healthcare. The research will be critical in de- veloping (1) specifics of the guideline to be implemented, and (2) supports provided via the SCS implementation strategy and the systems consultants who deliver it. The protocol will be determined to be feasible if we enroll four intervention clinics, deliver the intended intervention in all four clinics, follow the clinics for a 6-month period, and obtain quantitative and qualitative data from partici- pating clinicians. Acceptability will be gauged by assessing fidelity to the protocol and analysing qualitative data col- lected by the research team. We will continue to track ef- fectiveness measures through the end of the 3-year grant period using de-identified electronic health records (e.g. opioid prescribing rate by clinician, number of treatment agreements signed) to assess the preliminary effectiveness of the SCS on clinical practice. With eight clinics report- ing data (four intervention and four control clinics), we will be able to obtain baseline estimates of means and standard deviations for RE-AIM outcomes and point esti- mates of treatment effect sizes, thereby equipping us to conduct an accurate power calculation for the follow-up randomized trial. Potential problems and alternative strategies We are confident we can recruit four intervention clinics from our recruitment pool based on successful prior col- laboration between the University of Wisconsin Depart- ments of Industrial & Systems Engineering and DFMCH.
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