IMPACT Project 1 – The impact of standing orders support on clinical communication and health care use

Ongoing and pressing cancer prevention challenges in the US are related to infrequent and low-quality provider recommendations about primary care for children ages 9-12 years. Our 1-hour Announcement Approach Training (AAT) teaches providers about clinical communication in pediatrics and how to use best practices for respectfully addressing parent concerns when they arise. The AAT increases health care use and is an NCI-designated Cancer Control Program. To increase the impact of the AAT, we propose to leverage the whole primary care team, including registered nurses (RNs) and medical assistants (MAs), by supporting the implementation of existing standing orders. Standing orders are widely available but often underused. As part of the P01 Program Project, "Improving Provider Announcement Communication Training (IMPACT)," Project 1 will focus on AAT enhanced with standing orders support to expand the whole primary care team's involvement in making clinical recommendations for primary care. We will do this work in healthcare systems serving rural and nonrural areas. Aim 1 is to characterize the role of RNs and MAs and standing orders. We will conduct formative interviews (n=20) and then a national primary care team survey (n=2,500) with our P01's Data Core to better understand how to expand the role of RNs and MAs in clinical communication and to implement existing standing orders. Aim 2 is to evaluate the impact of supporting the implementation of existing standing orders for the whole primary care team in a cluster RCT. The standing orders support will be a series of activation meetings with system leaders, clinic leaders, and clinic staff. We will conduct a trial in up to 40 primary care clinics that have standing orders for routine primary care, serve patients from rural and nonrural areas, and are part of a healthcare system. Clinics will be randomized to AAT or AAT enhanced with standing orders support. The primary trial outcome will be increased health care use among children ages 9-12 years. We hypothesize that AAT with standing orders support increases health care use through improved clinical communication. Aim 3 is to generate guidance for healthcare systems to implement standing orders support. We will gather and share intervention data (cost, impact, and implementation data) with Project 4 to support cost-effectiveness analyses and development of their decision support tool. We will examine intervention implementation determinants and outcomes with our P01's Intervention Core. Finally, we will contribute modules to the AAT Intervention Package that provides guidance to healthcare systems for improving health care use. Project 1 addresses the IMPACT Program Project theme by building capacity for clinical communication interventions among primary care teams in healthcare systems.