Comparing traditional and participatory dissemination of a shared decision making intervention (ADAPT-NC): a cluster randomized trial

Abstract

BackgroundAsthma is a common disease that affects people of all ages and has significant morbidity and mortality. Poor outcomes and health disparities related to asthma result in part from the difficulty of disseminating new evidence and care delivery methods such as shared decision making (SDM) into clinical practice.This 3-year study explores the ideal framework for rapid dissemination of an evidence-based SDM toolkit for asthma management. The study leverages a partnership between the North Carolina (NC) statewide Medicaid network and the NC Network Consortium of practice-based research networks (PBRNs).Methods/designThis non-blinded study will randomize 30 primary care clinics in NC stratified by four PBRNs. We will test dissemination across these practices using a facilitator-led participatory approach to dissemination (FLOW), a novel method of participatory dissemination involving key principles of community-based participatory research, and a more typical “lunch and learn” dissemination method. Specifically, we will use cluster randomization to assign each of the 30 practices to one of three arms: (1) control, no dissemination; (2) traditional dissemination, one didactic session a year and distribution of educational material; and (3) FLOW dissemination. We hypothesize that at the unit of randomization, the clinic, patients in the FLOW dissemination arm will be more likely to share in their treatment decisions compared to patients in the traditional dissemination or control arms. All outcomes will be measured at the level of the clinic. Adoption of the SDM approach will be evaluated by 1) asthma exacerbations, 2) level of patient involvement in the decision making process, and 3) qualitative assessments from patients and providers.The research question is: What dissemination strategy most effectively increases practice level adoption of a shared decision making approach to asthma management? This study will provide important data to support best practices in dissemination of an evidence-based toolkit and implementation of shared decision making into primary care practices.Trial registrationThe trial was registered on January 27, 2014 through the United States National Institutes of Health’s ClinicalTrials.gov NCT02047929 and funded by the Patient-Centered Outcomes Research Institute (PCORI).

Asthma dissemination around patient-centered treatments in North Carolina (ADAPT-NC): a cluster randomized control trial evaluating dissemination of an evidence-based shared decision-making intervention for asthma management

“…The practice randomization was clustered geographically across four Practice Based Research Networks (PBRN). Two PBRNs, North [27]. The Consolidated Standards of Reporting Trials diagram summarizes the study design ( Figure 1).…”

“…The ACE Study facilitator-led method involved a participatory approach using 12-weeks of weekly engagement with each practice [26,27]. Each week a trained facilitator from the research team held hourlong meetings at the practice.…”

“…Key personnel from the practice were invited to each meeting to form a core team with a goal to work through tailoring the adoption of the SDM intervention to the culture of the practice. Typically, the core team was comprised of a provider champion, practice manager, health coach, nursing and registration staff [27].…”

“…The primary outcome of the study was patients' perceptions of having shared in the treatment decision at an asthma visit in the active dissemination arms. Secondary outcomes were health outcomes for patients with asthma, including ED utilization, hospitalizations, oral steroid prescriptions, and one or more of these three "markers" of exacerbation for all three arms [5,8,[26][27][28]. We hypothesized that practices receiving the facilitator-led dissemination approach would have a greater percentage of patients reporting having equally shared in the treatment decision about their asthma care with their provider than patients in the traditional lunch-and-learn practices.…”

Dissemination and Implementation Research for Occupational Safety and Health

“…Some illustrate use of an experimental design and quantitative comparison; others involve primarily qualitative assessment, using methods similar to those typical of process evaluation. Although not specific to occupational health, the clinical and community health literature offers additional examples of published D&I-related articles, including both experimental D&I studies (Dunn et al 2012; Nahm et al 2015; Tapp et al 2014) as well as studies that examine D&I constructs as part of their process evaluation (Hernandez et al 2017; Kennedy et al 2017; Northridge et al 2017). …”