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      Recruiting medical groups for research: relationships, reputation, requirements, rewards, reciprocity, resolution, and respect

      research-article
      1 ,
      Implementation Science
      BioMed Central

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          Abstract

          Background

          In order to conduct good implementation science research, it will be necessary to recruit and obtain good cooperation and comprehensive information from complete medical practice organizations. The goal of this paper is to report an effective example of such a recruitment effort for a study of the organizational aspects of depression care quality.

          Methods

          There were 41 medical groups in the Minnesota region that were eligible for participation in the study because they had sufficient numbers of patients with depression. We documented the steps required to both recruit their participation in this study and obtain their completion of two questionnaire surveys and two telephone interviews.

          Results

          All 41 medical groups agreed to participate and consented to our use of confidential data about their care quality. In addition, all 82 medical directors and quality improvement coordinators completed the necessary questionnaires and interviews. The key factors explaining this success can be summarized as the seven R's: Relationships, Reputation, Requirements, Rewards, Reciprocity, Resolution, and Respect.

          Conclusion

          While all studies will not have all of these factors in such good alignment, attention to them may be important to other efforts to add to our knowledge of implementation science.

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          Most cited references24

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          Physician response to surveys. A review of the literature.

          Physician-specific surveys are a frequently used tool in health services research, but attempts at ensuring adequate response rates are rarely reported. We reviewed literature of survey methodology specific to physician surveys and report those found to be most effective. Studies were identified by searching MEDLINE and PSYCHInfo from 1967 through February 1999. We included all English-language studies that randomized physician survey respondents to an experimental or control group. The authors independently extracted data from 24 studies examining survey methodology of physician-specific surveys. We included Mantel-Haenszel chi-squares comparing treatment groups, if present. If not, these were calculated from study data. Pre-notification of survey recipients, personalizing the survey mailout package, and nonmonetary incentives were not associated with increased response rates. Monetary incentives, the use of stamps on both outgoing and return envelopes, and short questionnaires did increase response rates. Few differences were reported in response rates of phone surveys compared with mail surveys and between the demographics and practice characteristics of early survey respondents and late respondents. We report some simple approaches that may significantly increase response rates of mail surveys. Surprisingly, the response rates of mail surveys of physicians compared favorably with those from telephone and personal interview surveys. Nonresponse bias may be of less concern in physician surveys than in surveys of the general public. Future research steps include specifically testing the more compelling results to allow for better control of confounders.
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            A practice change model for quality improvement in primary care practice.

            Faced with a rapidly changing healthcare environment, primary care practices often have to change how they practice medicine. Yet change is difficult, and the process by which practice improvement can be understood and facilitated has not been well elucidated. Therefore, we developed a model of practice change using data from a quality improvement intervention that was successful in creating a sustainable practice improvement. A multidisciplinary team evaluated data from the Study To Enhance Prevention by Understanding Practice (STEP-UP), a randomized clinical trial conducted to improve the delivery of evidence-based preventive services in 79 northeastern Ohio practices. The team conducted comparative case-study analyses of high- and low-improvement practices to identify variables that are critical to the change process and to create a conceptual model for the change. The model depicts the critical elements for understanding and guiding practice change and emphasizes the importance of these elements' evolving interrelationships. These elements are (1) motivation of key stakeholders to achieve the target for change; (2) instrumental, personal, and interactive resources for change; (3) motivators outside the practice, including the larger healthcare environment and community; and (4) opportunities for change--that is, how key stakeholders understand the change options. Change is influenced by the complex interaction of factors inside and outside the practice. Interventions that are based on understanding the four key elements and their interrelationships can yield sustainable quality improvements in primary care practice.
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              External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases.

              Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use. To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes). One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs. Extent of use of CMPs as calculated on the basis of a summary measure, a PO care management index (POCMI; range, 0-6) and factors associated with CMP use. Physician organizations' mean use of CMPs was 5.1 of a possible 16; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives-public recognition and better contracts for health care quality-was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<.001 and P =.007). Each additional IT capability was associated with 0.37 additional CMPs (P<.001). However, 33% of POs reported no external incentives and 50% reported no clinical IT capability. The use of CMPs varies greatly among POs, but it is low on average. Government and private purchasers of health care may increase CMP use by providing external incentives for improvement of health care quality to POs and by assisting them in improving their clinical IT capability.
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                Author and article information

                Journal
                Implement Sci
                Implementation Science
                BioMed Central (London )
                1748-5908
                2006
                26 October 2006
                : 1
                : 25
                Affiliations
                [1 ]HealthPartners Research Foundation, PO Box 1524, MS#21111R, Minneapolis MN 55440-1524, USA
                Article
                1748-5908-1-25
                10.1186/1748-5908-1-25
                1630695
                17067379
                f6018d21-e85d-4c00-a46c-c7e6cad8f896
                Copyright © 2006 Solberg; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 8 June 2006
                : 26 October 2006
                Categories
                Research Article

                Medicine
                Medicine

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