The purpose of this study is to design and evaluate targeted implementation strategies to fully integrate the VHA clinical practice guidelines for ischemic heart disease into VHA clinical practice. Effectively implementing the guideline will enhance the quality, appropriateness, timeliness, and cost effectiveness of care delivered to veterans with ischemic heart disease. The long-term objective of this study is to identify the best strategies for implementing the IHD guidelines to improve guideline adherence and provider acceptance. The specific objectives of the study are to: (1) describe the temporal aspects of guideline acceptance and adherence, over three periods of time: pre-implementation, post implementation of general strategies, and post- implementation of targeted strategies; (2) assess the relative effectiveness of targeted intervention strategies on guideline adherence; (3) identify the relationships among provider beliefs, attitudes, and their intentions to use guidelines; (4) identify the costs associated with implementation of general and targeted implementation strategies; and (5) describe provider satisfaction with targeted implementation strategies. Qualitative (focus groups, interviews with key informants) and quantitative methods (surveys, chart reviews) are used to address study objectives. A survey will be sent to providers to measure beliefs and attitudes that predict provider acceptance to clinical practice guidelines. Patient level data will be collected from reviews of charts from each facility. Based on provider focus groups we will design targeted strategies to overcome system barriers and address needs identified by providers to support clinical practice guideline implementation. A randomized trial will be conducted to assess the relative effectiveness of the targeted intervention strategies.

Condition	Treatment or Intervention
Myocardial Ischemia Heart Disease Coronary Disease	Device: Personal Digital Assistant (PDA)

Further Study Details: 

Expected Total Enrollment:  9789

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Accepts Healthy Volunteers

Criteria

Patients: Ischemic heart patients. Providers: All physician, physician assistants and advanced registered nurse practitioners providers on medical services who are likely to care for IHD patients and who have a significant direct care responsibility greater than 35% of their time allocated to direct patient care are included. These services include cardiology, internal medicine, and ambulatory/primary care.

Florida
      James A. Haley VA Medical Center, Tampa,  Florida,  33612,  United States

Study ID Numbers:  VCR 99-014
Record last reviewed:  October 2000
Last Updated:  October 13, 2004
Record first received:  March 14, 2001
ClinicalTrials.gov Identifier:  NCT00013104
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08