LEADER 04442nam 22006374a 450 001 9910220134303321 005 20200520144314.0 035 $a(CKB)1000000000474849 035 $a(EBL)784088 035 $a(OCoLC)781422377 035 $a(SSID)ssj0000276955 035 $a(PQKBManifestationID)11231506 035 $a(PQKBTitleCode)TC0000276955 035 $a(PQKBWorkID)10226293 035 $a(PQKB)10258002 035 $a(SSID)ssj0000280633 035 $a(PQKBManifestationID)11207437 035 $a(PQKBTitleCode)TC0000280633 035 $a(PQKBWorkID)10299918 035 $a(PQKB)11085513 035 $a(Au-PeEL)EBL784088 035 $a(CaPaEBR)ebr10152608 035 $a(MiAaPQ)EBC784088 035 $a(oapen)doab114599 035 $a(EXLCZ)991000000000474849 100 $a20050307d2005 uy 0 101 0 $aeng 135 $aurcn||||||||| 181 $ctxt$2rdacontent 182 $cc$2rdamedia 183 $acr$2rdacarrier 200 00$aImplementation of the asthma practice guideline in the Army Medical Department $eevaluation of process and effects /$fDonna O. Farley ... [et al.] 205 $a1st ed. 210 $aSanta Monica, CA $cRand$dc2005 215 $a1 online resource (xxxiv, 176 pages) $cillustrations 300 $aDescription based upon print version of record. 311 1 $a0-8330-4073-1 311 1 $a0-8330-3773-0 320 $aIncludes bibliographical references (p. 173-176). 327 $aPreface; Contents; Figures; Tables; Summary; Acknowledgments; Abbreviations; CHAPTER ONE- Introduction; Overview of the Military Health System; The DoD/VA Guideline Adaptation Process; The AMEDD-RAND Guideline Implementation Project; Overview of the Asthma Practice Guideline; A Systems Approach to Implementation; The AMEDD Guideline Implementation Process; The Demonstration Sites; The RAND Evaluation; Organization of This Report; CHAPTER TWO- Methods and Data; Process Evaluation Methods; Outcome Evaluation; Estimating the Costs of Care 327 $aCHAPTER THREE- Asthma Populations and Practices at the Baseline The Asthma Population Served by Army MTFs; Baseline Performance on Asthma Care Measures at the Study MTFs; Summary; CHAPTER FOUR- The Guideline Implementation Process; MEDCOM Support; Structure and Support at the MTFs; Implementation Activities and Progress; Lessons Learned; CHAPTER FIVE- Effects of Guideline Implementation; Provider Knowledge and Acceptance of the Guideline; Reported Changes in Clinical Practices; Analysis of Effects on Service Delivery; Estimated Costs of Care; Summary 327 $aCHAPTER SIX- Synthesis of Findings from the Demonstration Findings on the Implementation Process; Effects of Implementing Practice Improvements; Data Issues; Recommendations; APPENDIX A- Hypotheses for Effects of Improved Asthma Care Practices; APPENDIX B- Evaluation Methodology; APPENDIX C- Modules of the Climate Survey; APPENDIX D- Physician Questionnaire; APPENDIX E- Analyses of Asthma Metrics; Bibliography 330 $aIn partnership with the Army Medical Department (AMEDD), RAND researchers worked to implement clinical practice guidelines in treatment of three common ailments (asthma, diabetes, and low back pain). This report is an evaluation of the asthma practice guideline demonstration. It documents the extent to which intended actions were implemented, assesses short-term effects on clinical practices, and measures the quality and limitations of available data for monitoring practice improvements and clinical outcomes. The authors found that, although the implementation scored some notable successes, resource limitations and organizational barriers curbed overall progress. They conclude that allowing for flexibility, monitoring the facilities consistently, and training providers thoroughly are the keys to implementing the practice guidelines throughout AMEDD. The also concluded that patient education was an area in need of improvement 606 $aAsthma$xTreatment$zUnited States 615 0$aAsthma$xTreatment 676 $a616.2/3806 701 $aFarley$b Donna$0848919 712 02$aArroyo Center. 712 02$aCenter for Military Health Policy Research. 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910220134303321 996 $aImplementation of the asthma practice guideline in the Army Medical Department$91927800 997 $aUNINA