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In 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.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Introduction

  • Chapter Three

    Asthma Populations and Practices at the Baseline

  • Chapter Four

    The Guideline Implementation Process

  • Chapter Five

    Effects of Guideline Implementation

  • Chapter Six

    Synthesis of Findings from the Demonstration

  • 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

Research conducted by

The research described in this report was sponsored by the United States Army and conducted by the RAND Arroyo Center.

This report is part of the RAND Corporation monograph series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND monographs undergo rigorous peer review to ensure high standards for research quality and objectivity.

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