ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Background: In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity.

Objectives: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines.

ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Background: In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity.

Objectives: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines.

Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.

Background: Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown.

Objective: To develop SNF-specific antibiograms and identify opportunities to improve antibiotic prescribing.

Design And Setting: Cross-sectional and pretest-posttest study among residents of 3 Maryland SNFs.

2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults.

Effects of clinical pathways for common outpatient infections on antibiotic prescribing.

Background: Antibiotic overuse in the primary care setting is common. Our objective was to evaluate the effect of a clinical pathway-based intervention on antibiotic use.

Methods: Eight primary care clinics were randomized to receive clinical pathways for upper respiratory infection, acute bronchitis, acute rhinosinusitis, pharyngitis, acute otitis media, urinary tract infection, skin infections, and pneumonia and patient education materials (study group) versus no intervention (control group).

A discharge panel at Denver Health, focused on complex patients, may have influenced decline in length-of-stay.

Acute care hospitals struggle to manage complex patients who no longer require acute care services but who present medical and psychosocial challenges that make safe discharge to a lower level of care difficult. These challenges can be particularly acute at safety-net hospitals that cater predominantly to the poor and uninsured. For a person with a serious illness, such as a spinal cord injury, lack of insurance for long-term care services may add many weeks of medically unnecessary hospital days and result in higher costs.

Care by cell phone: text messaging for chronic disease management.

Objectives: To assess the feasibility of engaging adults with diabetes in self management behaviors between clinic visits by using cell phone text messaging to provide blood sugar measurement prompts and appointment reminders.

Study Design: Quasi-experimental pilot among adult diabetic patients with cell phones who receive regular care at a federally qualified community health center in Denver, Colorado, which serves a population that is predominantly either uninsured (41%) or on Medicaid or Medicare (56%).

Methods: Patients (N = 47) received text message prompts over a 3-month period.

Nurse-run, telephone-based outreach to improve lipids in people with diabetes.

Background: There is a need for randomized, prospective trials of case management interventions with resource utilization analyses.

Objectives: To determine whether algorithm-driven telephone care by nurses improves lipid control in patients with diabetes.

Design: Prospective, randomized, controlled trial.

Vital sign abnormalities, rapid response, and adverse outcomes in hospitalized patients.

Rapid response activation (RRA), triggered chiefly by surpassing threshold vital sign abnormalities (TVSAs), is designed to intervene at the earliest point in a patient's deteriorating course. The authors aimed to quantify the incidence of TVSA among patients hospitalized on acute care units in a hospital that uses rapid response. During the course of 6 months, the authors compared adverse events (mortality, unexpected intensive care unit [ICU] transfers, and cardiopulmonary arrest) and TVSA among patients who triggered an RRA, patients with TVSAs and no RRA, and all other patients.

"Leaning" the process of venous thromboembolism prophylaxis.

Background: Lean principles have been used at Denver Health Medical Center since 2005 to streamline nonclinical processes. Despite allocation of significant resources, particularly the expense of low molecular weight heparin (LMWH), to prophylaxis of venous thromboembolism (VTE), the incidence of postoperative VTE was significantly worse than national benchmarks. VTE risk factors were not consistently assessed, and the prescribing of prophylaxis varied widely.

Diabetes population management by telephone visits.

Introduction: Little has been published on the impact of telephone visits on diabetes outcome performance.

Research Design And Methods: An attending and resident physician prioritized telephone visits based on glycemic, blood pressure, and lipid performance. The resident and attending panel was compared with all other diabetic patients at the clinic for baseline and end-intervention performance.

A computerized education module improves patient knowledge and attitudes about appropriate antibiotic use for acute respiratory tract infections.

Background: Over-use of antibiotics for acute respiratory infections (ARIs) increases antimicrobial resistance, treatment costs, and side effects. Patient desire for antibiotics contributes to over-use.

Objective: To explore whether a point-of-care interactive computerized education module increases patient knowledge and decreases desire for antibiotics.

The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial.

Background: Most studies of diabetes self-management that show improved clinical outcome performance involve multiple, time-intensive educational sessions in a group format. Most provider performance feedback interventions do not improve intermediate outcomes, yet lack targeted, patient-level feedback.

Methods: 5,457 low-income adults with diabetes at eight federally-qualified community health centers participated in this nested randomized trial.

The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial.

Background: We conducted an Internet-based randomized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease (CVD) for people with newly diagnosed hypertension to determine which framing presentation resulted in choices most consistent with participants' values.

Methods And Findings: In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company, adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales (VAS). Participants viewed information (or no information) to which they were randomized and decided whether or not to take medication.

Incident chronic kidney disease and the rate of kidney function decline in individuals with hypertension.

Background: Little is known about the decline of kidney function in patients with normal kidney function at baseline. Our objectives were to (i) identify predictors of incident chronic kidney disease (CKD) and (ii) to estimate rate of decline in kidney function.

Methods: The study used a retrospective cohort of adult patients in a hypertension registry in an inner-city health care delivery system in Denver, Colorado.

The effect of alternative graphical displays used to present the benefits of antibiotics for sore throat on decisions about whether to seek treatment: a randomized trial.

Background: We conducted an Internet-based randomized trial comparing four graphical displays of the benefits of antibiotics for people with sore throat who must decide whether to go to the doctor to seek treatment. Our objective was to determine which display resulted in choices most consistent with participants' values.

Methods And Findings: This was the first of a series of televised trials undertaken in cooperation with the Norwegian Broadcasting Company.

Treatment of osteopenia and osteoporosis in anorexia nervosa: a systematic review of the literature.

Objective: To systematically review the evidence supporting treatment of osteopenia and osteoporosis in patients with anorexia nervosa (AN).

Data Sources: We identified controlled clinical studies of interventions for low bone mass in AN via searches of MEDLINE; the Cochrane Library; EMBASE; PsycINFO; and cumulative index to nursing and allied health literature. Outcomes of interest were changes in bone mineral density and fracture incidence.

Emergence of fluoroquinolone resistance in outpatient urinary Escherichia coli isolates.

Background: Because of high rates of trimethoprim-sulfamethoxazole resistance in Escherichia coli, Denver Health switched to levofloxacin as the initial therapy for urinary tract infections (UTIs) in 1999. We evaluated the effects of that switch 6 years later.

Methods: Levofloxacin prescriptions per 1000 outpatient visits and levofloxacin resistance in outpatient E.

Acceptability of a bilingual interactive computerized educational module in a poor, medically underserved patient population.

We evaluated the acceptability and impact of an audiovisual, bilingual, interactive computer module relating to appropriate antibiotic use. In winter 2001, adults seeking urgent care for acute respiratory infections at an inner-city urgent care clinic were invited to complete the computer module and survey (N = 296). After responding to questions about their symptoms, patients were provided information about their illness and appropriate antibiotic use, and then asked several questions about the acceptability of the module.

Lack of ethnic disparities in adult immunization rates among underserved older patients in an urban public health system.

Background: In some settings, immunization rates for ethnic minorities are less than those of non-Hispanic white populations. This study examines demographic differences in the rate of pneumococcal and influenza immunization in an ethnically diverse older patient population seeking care at an urban primary care clinic system.

Methods: The setting is an integrated system of 11 federally qualified community health centers serving approximately 100,000 unduplicated patients annually.

Bridging the quality gap in diabetic hyperlipidemia: a practice-based intervention.

Purpose: Dyslipidemia treatment dramatically decreases coronary heart disease risk in diabetes, yet only a minority of these patients are screened or achieve optimal low-density lipoprotein (LDL) cholesterol levels. Our aim was to increase the percentage of diabetic patients in whom lipid management was achieved through electronic and direct educational detailing.

Methods: The study cohort comprised 884 diabetic patients at 12 primary care practices.

Smoking abstinence after hospitalization: predictors of success.

Background: Our objective was to explore the relationship between baseline characteristics of hospitalized smokers and 6-month to 2-year self-reported quit rates.

Methods: We surveyed adult smokers (n = 154) admitted to the Medicine service of an urban public hospital. We used the pharmacy database, a follow-up telephone survey, and medical records to characterize nicotine patch use and post-discharge smoking abstinence.

Conventional and molecular epidemiology of trimethoprim-sulfamethoxazole resistance among urinary Escherichia coli isolates.

Background: Antibiotic resistance is increasing in Escherichia coli, the most common cause of urinary tract infections, but its epidemiology has not been well described. We evaluated the epidemiology of trimethoprim-sulfamethoxazole-resistant E. coli in a large, public health care system in Denver, Colorado.