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Grant Details

Grant Number: 5R01CA060862-14 Interpret this number
Primary Investigator: Stange, Kurt
Organization: Case Western Reserve University
Project Title: Practice Outcomes in Community & Healthcare Systems
Fiscal Year: 2008
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Abstract

DESCRIPTION (provided by applicant): Primary care practices are uniquely situated to deliver effective preventive services to the majority of Americans. However, because of most practices' limited capacity to change and isolation from systems and community resources, this potential has not been met. Our prior research has developed a community practice laboratory for cancer control research. In observational studies we discovered novel opportunities for practice-individualized approaches to enhancing prevention. Applying these insights in the STEP-UP clinical trial demonstrated sustainable increases in preventive service delivery. Multimethod process assessments of high and low change practices produced a new model for a multilevel, multistage intervention that engages practice, community and healthcare system resources. The proposed competing continuation project is a group randomized clinical trial. Thirty primary care practices, stratified by health care system affiliation, will be randomized to initial or delayed intervention groups. The intervention begins with a multimethod assessment of the capacity to change of each practice and its community and healthcare system. Insights from this assessment will inform a participatory approach to building practice change capacity and community and health care system linkages. These new capacities and connections will then be used to tailor sustainable approaches to preventive service delivery. The hypothesized effects of the intervention will be assessed on: practices' capability for change, rate of delivery of US Preventive Services Task Force-recommended preventive services, and patient and clinician satisfaction. Multilevel modeling will be used to control for clustering and any baseline differences between groups. Using an innovative set of multimethod procedures, the process of change will be assessed. The resulting insights will be used to design a refined multilevel intervention. This refined intervention will be implemented and evaluated in the delayed intervention group using a pre-post design, while long-term outcomes continue to be assessed in the initial intervention group. The resulting knowledge will be transportable to other systems seeking to improve the quality of health care.

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Publications

How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.
Authors: Lanham HJ, McDaniel RR Jr, Crabtree BF, Miller WL, Stange KC, Tallia AF, Nutting P
Source: Jt Comm J Qual Patient Saf, 2009 Sep;35(9), p. 457-66.
PMID: 19769206
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An appreciative inquiry approach to practice improvement and transformative change in health care settings.
Authors: Carter CA, Ruhe MC, Weyer S, Litaker D, Fry RE, Stange KC
Source: Qual Manag Health Care, 2007 Jul-Sep;16(3), p. 194-204.
PMID: 17627214
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Physician practice patterns and variation in the delivery of preventive services.
Authors: Flocke SA, Litaker D
Source: J Gen Intern Med, 2007 Feb;22(2), p. 191-6.
PMID: 17356985
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Physician and patient gender concordance and the delivery of comprehensive clinical preventive services.
Authors: Flocke SA, Gilchrist V
Source: Med Care, 2005 May;43(5), p. 486-92.
PMID: 15838414
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Physicians' attitudes and preventive care delivery: insights from the DOPC study.
Authors: Litaker D, Flocke SA, Frolkis JP, Stange KC
Source: Prev Med, 2005 May;40(5), p. 556-63.
PMID: 15749138
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Features of medical records in community practices and their association with preventive service delivery.
Authors: Weyer SM, Konrad N, Esola D, Goodwin MA, Stange KC, Flocke SA
Source: Med Care, 2005 Jan;43(1), p. 28-33.
PMID: 15626931
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Direct observation and patient recall of health behavior advice.
Authors: Flocke SA, Stange KC
Source: Prev Med, 2004 Mar;38(3), p. 343-9.
PMID: 14766118
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Relationships between physician practice style, patient satisfaction, and attributes of primary care.
Authors: Flocke SA, Miller WL, Crabtree BF
Source: J Fam Pract, 2002 Oct;51(10), p. 835-40.
PMID: 12401151
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Addressing the unique challenges of inner-city practice: a direct observation study of inner-city, rural, and suburban family practices.
Authors: Blankfield RP, Goodwin M, Jaén CR, Stange KC
Source: J Urban Health, 2002 Jun;79(2), p. 173-85.
PMID: 12023493
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Does health habit counseling affect patient satisfaction?
Authors: Barzilai DA, Goodwin MA, Zyzanski SJ, Stange KC
Source: Prev Med, 2001 Dec;33(6), p. 595-9.
PMID: 11716655
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Time use in clinical encounters: are African-American patients treated differently?
Authors: Oliver MN, Goodwin MA, Gotler RS, Gregory PM, Stange KC
Source: J Natl Med Assoc, 2001 Oct;93(10), p. 380-5.
PMID: 11688918
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Practice jazz: understanding variation in family practices using complexity science.
Authors: Miller WL, McDaniel RR Jr, Crabtree BF, Stange KC
Source: J Fam Pract, 2001 Oct;50(10), p. 872-8.
PMID: 11674890
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Race and preventive services delivery among black patients and white patients seen in primary care.
Authors: Williams RL, Flocke SA, Stange KC
Source: Med Care, 2001 Nov;39(11), p. 1260-7.
PMID: 11606879
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A clinical trial of tailored office systems for preventive service delivery. The Study to Enhance Prevention by Understanding Practice (STEP-UP).
Authors: Goodwin MA, Zyzanski SJ, Zronek S, Ruhe M, Weyer SM, Konrad N, Esola D, Stange KC
Source: Am J Prev Med, 2001 Jul;21(1), p. 20-8.
PMID: 11418253
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Facilitating participatory decision-making: what happens in real-world community practice?
Authors: Gotler RS, Flocke SA, Goodwin MA, Zyzanski SJ, Murray TH, Stange KC
Source: Med Care, 2000 Dec;38(12), p. 1200-9.
PMID: 11186299
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Billing for physician services: a comparison of actual billing with CPT codes assigned by direct observation.
Authors: Chao J, Gillanders WG, Flocke SA, Goodwin MA, Kikano GE, Stange KC
Source: J Fam Pract, 1998 Jul;47(1), p. 28-32.
PMID: 9673605
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The effect of a secondary patient on the family practice visit.
Authors: Flocke SA, Goodwin MA, Stange KC
Source: J Fam Pract, 1998 May;46(5), p. 429-34.
PMID: 9598002
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Opportunistic preventive services delivery. Are time limitations and patient satisfaction barriers?
Authors: Stange KC, Flocke SA, Goodwin MA
Source: J Fam Pract, 1998 May;46(5), p. 419-24.
PMID: 9598000
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The impact of recent emotional distress and diagnosis of depression or anxiety on the physician-patient encounter in family practice.
Authors: Callahan EJ, Jaén CR, Crabtree BF, Zyzanski SJ, Goodwin MA, Stange KC
Source: J Fam Pract, 1998 May;46(5), p. 410-8.
PMID: 9597999
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Primary care practice organization and preventive services delivery: a qualitative analysis.
Authors: Crabtree BF, Miller WL, Aita VA, Flocke SA, Stange KC
Source: J Fam Pract, 1998 May;46(5), p. 403-9.
PMID: 9597998
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Understanding change in primary care practice using complexity theory.
Authors: Miller WL, Crabtree BF, McDaniel R, Stange KC
Source: J Fam Pract, 1998 May;46(5), p. 369-76.
PMID: 9597994
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Direct observation of community-based ambulatory encounters involving medical students.
Authors: Frank SH, Stange KC, Langa D, Workings M
Source: JAMA, 1997 Sep 3;278(9), p. 712-6.
PMID: 9286829
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