UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date

2011-09-09

Document Type

Article

Subjects

Veterans Health; Veterans; Randomized Controlled Trials as Topic

Disciplines

Biostatistics | Epidemiology | Health Services Research

Abstract

BACKGROUND: The Veterans Health Administration (VHA) oversees the largest integrated healthcare system in the United States. The feasibility of a large-scale, nationwide, group-randomized implementation trial of VHA outpatient practices has not been reported. We describe the recruitment and enrollment of such a trial testing a clinician-directed, Internet-delivered intervention for improving the care of postmyocardial infarction patients with multiple comorbidities.

METHODS: With a recruitment goal of 200 eligible community-based outpatient clinics, parent VHA facilities (medical centers) were recruited because they oversee their affiliated clinics and the research conducted there. Eligible facilities had at least four VHA-owned and -operated primary care clinics, an affiliated Institutional Review Board (IRB), and no ongoing, potentially overlapping, quality-improvement study. Between December 2003 and December 2005, in two consecutive phases, we used initial and then intensified recruitment strategies.

RESULTS: Overall, 48 of 66 (73%) eligible facilities were recruited. Of the 219 clinics and 957 clinicians associated with the 48 facilities, 168 (78%) clinics and 401 (42%) clinicians participated. The median time from initial facility contact to clinic enrollment was 222 days, which decreased by over one-third from the first to the second recruitment phase (medians: 323 and 195 days, respectively; p < .001), when more structured recruitment with physician recruiters was implemented and a dedicated IRB manager was added to the coordinating center staff.

CONCLUSIONS: Large group-randomized trials benefit from having dedicated physician investigators and IRB personnel involved in recruitment. A large-scale, nationally representative, group-randomized trial of community-based clinics is feasible within the VHA or a similar national healthcare system.

Keywords

UMCCTS funding

Rights and Permissions

© 2011 Funkhouser et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

DOI of Published Version

10.1186/1748-5908-6-105

Source

Implement Sci. 2011 Sep 9;6:105. doi:10.1186/1748-5908-6-105. The electronic version of this article is the complete one and can be found online at: http://www.implementationscience.com/content/6/1/105

Journal/Book/Conference Title

Implementation science : IS

PubMed ID

21906278

Related Resources

Link to Article in PubMed

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