Strategies for increasing adherence to clinical guidelines and improving patient outcomes in small primary care practices

Jt Comm J Qual Saf. 2004 Aug;30(8):432-41. doi: 10.1016/s1549-3741(04)30049-3.


Background: The best way to get research findings into practice needs to be determined, particularly in small practices. The Practice Partner Research Network (PPRNet) is a nationwide practice-based research network of small primary care practices that use the same electronic medical record (EMR). Between 2000-2003 the PPRNet Translating Research into Practice (TRIP) project tested a multimethod intervention to help practices improve primary and secondary prevention of cardiovascular disease and stroke. Intervention sites each hosted six to seven site visits and participated in two annual network meetings during the two-year intervention period. A model describing practice-based improvement strategies was validated using prospective data from 10 intervention and 9 control sites.

Results: The model consisted of five categories of improvement strategies: Prioritize Performance, Involve All Staff, Redesign Delivery Systems, Activate Patients, and Use EMR Tools. PPRNet-TRIP intervention practices used more of the model items than did controls (69% versus 48%, p = .053), as did high-performing practices versus mid-range or low performers (81% versus 39% versus 46%, p = .001).

Conclusion: The PPRNet-TRIP Improvement Model might guide small practices in their efforts to translate research into practice and improve care outcomes.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Coronary Disease / prevention & control
  • Coronary Disease / therapy
  • Guideline Adherence / organization & administration*
  • Humans
  • Outcome Assessment, Health Care / organization & administration*
  • Primary Health Care / organization & administration*
  • Stroke / prevention & control
  • Stroke / therapy