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Implement Sci. 2008 May 16;3:25. doi: 10.1186/1748-5908-3-25.

Association of intervention outcomes with practice capacity for change: subgroup analysis from a group randomized trial.

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1
Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA. David.Litaker@va.gov

Abstract

BACKGROUND:

The relationship between health care practices' capacity for change and the results and sustainability of interventions to improve health care delivery is unclear.

METHODS:

In the setting of an intervention to increase preventive service delivery (PSD), we assessed practice capacity for change by rating motivation to change and instrumental ability to change on a one to four scale. After combining these ratings into a single score, random effects models tested its association with change in PSD rates from baseline to immediately after intervention completion and 12 months later.

RESULTS:

Our measure of practices' capacity for change varied widely at baseline (range 2-8; mean 4.8 +/- 1.6). Practices with greater capacity for change delivered preventive services to eligible patients at higher rates after completion of the intervention (2.7% per unit increase in the combined effort score, p < 0.001). This relationship persisted for 12 months after the intervention ended (3.1%, p < 0.001).

CONCLUSION:

Greater capacity for change is associated with a higher probability that a practice will attain and sustain desired outcomes. Future work to refine measures of this practice characteristic may be useful in planning and implementing interventions that result in sustained, evidence-based improvements in health care delivery.

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