Oregon Rural Practice-Based Network

The Oregon Rural Practice-Based Research Network (ORPRN) is a statewide network of rural primary care clinicians working to improve health care through community and practice-based clinical research. The network is a collaboration between Oregon Health & Science University and the participating primary care clinicians and their practices. The mission of ORPRN is to improve the health of rural populations in Oregon through conducting and promoting health research in partnership with the communities and practitioners they serve.  Headquartered in Portland, the network also has regional Practice Enhancement and Research Coordinators (PERCs) across the state that live and work in these communities. ORPRN has a membership of 49 practices and 157 clinician members (physicians, physician assistants, and nurse practitioners). The practices are located in 37 communities throughout rural Oregon and care for over 235,500 patients.

The goals of ORPRN for the demonstration project are two-fold. First, the group will conduct a cross-sectional survey of clinicians and staff at 49 ORPRN clinics about their understanding, attitudes, and practices regarding shared decision-making. Second, the network will use a participatory research approach to facilitate the implementation of decision aids at six ORPRN clinics, studying the impact and acceptability of decision aid use from the clinician, practice, and patient perspectives.

The network will use a staggered implementation approach, focusing on implementation at four ORPRN clinics during year one. Two of the clinics are private practices and two are not-for profit. These clinics employ between 4 and 10 physicians and serve between 5,000 and almost 10,000 patients. ORPRN staff also hopes to engage local community partners in order to raise awareness about the benefits and approaches to shared decision-making.

A Participation Approach

A participatory research framework sets the foundation for this project to implement decision aids in rural primary. This participatory approach will include a preliminary assessment by the ORPRN team using qualitative and quantitative procedures at each participating site to gather information from clinic personnel about their attitudes regarding shared decision-making and readiness to implement decision aids. Each clinic site will also select a leadership team consisting of staff representatives from the front and back office and a clinician champion. This team will collaborate with the ORPRN staff to select decision aids for use in each clinic setting. 

Implementation Plan

Information from the preliminary assessment will be interpreted with the cross-functional team in order to develop a strategy for decision aid implementation given the features and resources at each unique practice. Implementation will be tailored based on iterative planning with the clinic leadership team, refined using PDSA (Plan-Do-Study-Act) cycles, and rolled out sequentially at each of the four clinics during months 7 to 10 of the project. During study implementation the team plans to:

• Engage providers and staff in all phases of study planning and development;
• Conduct a preliminary assessment of staff and clinicians;
• Work cooperatively with clinic leadership team to identify which decision aids are to be used at each clinic and plan implementation;
• Develop a procedure for data tracking in conjunction with clinic staff that would identify eligible patients, patient who received a decision aid, and patients who viewed a decision aid. Such an approach may involve using a shared decision-making study card and/or the collection of weekly data from a clinic’s electronic health record;
• Use direct observation, focus groups, structured individual interviews, and patient questionnaires to assess the implementation process; and
• Create a framework for changes in practice related to decision aid implementation that can be used as a guide for other primary care practices.
  

A Learning Community

To support dissemination of best practices for decision aid implementation, the project team will facilitate the development of a learning community with monthly phone calls involving representatives from each clinic’s cross-functional team, PERCs, and the study investigators. The study team will also encourage project leaders to visit other shared decision-making sites and plans for clinic leaders to present the results of the project at the 2010 ORPRN Convocation and at other national and regional meetings. Additional information about ORPRN can be found online at http://www.ohsu.edu/orprn/. For more information about this implementation project, please contact Practice Enhancement and Research Coordinator Melinda Davis at davismel@ohsu.edu.