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PPRNet - Primary (Care) Practices Research Network

Putting TRIP into your Practice: The PPRNet-TRIP Model

One of the main goals of Translating Research into Practice (TRIP) is to diseminate the PPRNet-TRIP quality improvement model to a greater number of practices (view article from this project). The improvement model incorporated evidence-based strategies of teamwork, organizational change, patient activation, individualized and population-based medicine, and electronic medical record (EMR) tools. This model, derived from literature, best practices' approaches and PPRNet-TRIP data has the following components:

Prioritize Performance:

  • Learn and accept current clinical guidelines
  • Establish project leader(s)
  • Use PPRNet reports to guide improvement activities
  • Actively supervise project roles and performance
  • Motivate the practice for improvement, using positive reinforcement and incentives
  • Advertise the project to patients and other providers

Involve All Staff:

  • Train staff on guidelines and practice improvement objectives
  • Have staff attend regular improvement meetings
  • Encourage all staff to participate in improvement efforts
  • Arrange communication loops between doctors and staff for quality improvement measures
  • Extend staff roles in care delivery
  • Have staff systematically reinforce information from the guidelines to patients
  • Have staff participate in outreach to patients using inquiries and reminders
  • Minimize staff turnover by including staff in improvement efforts, motivating staff, and providing incentives

Delivery System Redesign:

  • Use tests at the point-of-care (e.g., cholesterol, A1C)
  • Schedule lab before office visits
  • Extend staff’s role in testing (e.g., create standing orders)
  • Assign routine monitoring to staff (e.g., BP checks, lab visit or f/up)
  • Assign routine care management to FNP or PA
  • Establish protocols for periodic disease management visits
  • Make follow-up scheduling easy (advance scheduling or reminders)
  • Reach out to patients due for follow-up (reminder call, tickler system, recall letter)
  • Track whether follow-up occurs
  • Contact “no-shows”
  • Limit phone refills when visits or labwork is needed
  • Establish protocols for follow-up of pts not at goal

Patient Activation:

  • Provide written information re: guidelines and patient’s status
  • Distribute the A-TRIP patient education handout to patients to make patients more aware of guidelines
  • Reinforce messages with office posters, patient handouts
  • Reinforce messages and reach “absent” patients with practice newsletters
  • Provide incentives to meet guidelines (discounted screening, rewards, recognition)

Population-based Medicine

Outreach or reminders to sub-groups identified by inquiries or other data lists with subsequent follow-up (e.g., generate lists of diabetic patients not at goal A1C and contact these patients to schedule office visits)

EMR Tools:

  • Planned Visits – templates with guideline prompts
  • Decision Aids - flow sheets, results tables, summaries, Knowledge Base
  • Team Coordination - internal messaging, flags
  • Self-Reminders - internal messaging, flags, notes
  • Patient Education - personalized letters, links to handouts
  • Follow-Up - advance scheduling or billing recalls
  • Outreach – letters, addressing, phone calls
  • Lab Information – use interface integrated into EMR
  • Speed & Capacity - maximize computer hardware and software (upgrades, licenses)


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