HSR&D Home » Research » TRX 01-091 – HSR&D Study
Systematic Review and Tracking Databases for CPG Implementation
Valerie Ann Lawrence, MD MSc BA
South Texas Health Care System, San Antonio, TX
San Antonio, TX
Funding Period: July 2003 - June 2008
It is difficult to determine from available research what organizational strategies work best for chronic illness care due to methodological problems, lack of published details, and difficulties in accessing relevant evidence in bibliographic and grant databases.
Objective 1: a systematic review of research evidence to identify effective organizational interventions to implement clinical evidence for high priority chronic illnesses relevant to the VA [SynERGI]. Objective 2: a database (GUIDE) of research in progress to track new studies of organizational interventions to implement clinical evidence.
Systematic review of published and in progress research of interventions explicitly targeting organizational structures or processes using: a modified taxonomy from the EPOC which was mapped onto the Chronic Care Model (CCM) for coding; a highly sensitive search strategy using disease-specific terms that is generalizable to any disease; and a detailed, iterative group process to develop explicit disease-specific inclusion and exclusion criteria.
SynERGI: Medline searches through 7/17/2008 identified 27,341 potentially relevant citations. Disease-specific eligible studes for each of the following VA-relevant diseases are: DM (total citations:eligible studies; 8,127:52); COPD (1,979:10); CHF (2,559:30); colorectal cancer (1,480: 0); Depression (3,707; 19); SCI (359:0); and HIV (1,988:3). For abstractions to date, delivery system redesign was the most frequently used "organizational" CCM element (97 trials), compared to information system support (53 trials) and health care system support (17 trials). Use of different CCM organizational strategies varied greatly across the different illnesses, and was most frequent in diabetes, followed by CHF trials. The most frequently used combination of CCM elements was delivery system redesign + patient self-management support (28 trials). The majority of interventions were multi-component and averaged 3 strategies per study. No trial used all 6 CCM elements; the most used in any single trial was 4. GUIDE: Searches of the ClinicalTrials.gov website to identify research in progress using organizational interventions identified 3,399 potentially relevant active trials in CY2006. Of these, 83 met eligibility criteria: multidisease-20; IHD-39; diabetes-33; depression-10; CHF-9; COPD-9; and HIV-6. Among eligible trials, most (57, 68%) used delivery system redesign, 43 (51%) used information system support, and 4 (0.5%) utilized health care system support. Potentially eligible citations in 2007 were: IHD (696 total: 62 potentially eligible); COPD (42:8); HIV (88:10); depression (122:25); diabetes (228:22); and CHF (43:9).
Results will allow researchers and clinicians to more easily identify innovative cutting-edge organizational research to improve healthcare and inform QUERI and QI efforts within the VA.
External Links for this Project
Dimensions for VADimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.
If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/
VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address. Search Dimensions for this project
DRA: Health Systems
Keywords: Clinical practice guidelines
MeSH Terms: none