ABATE Infection

ABATE Infection, an NIH Collaboratory Trial, was a cluster randomized pragmatic trial of universal chlorhexidine bathing and nasal decolonization compared with usual care in in 53 hospitals with 194 non–critical care units. The study team found that universal decolonization and targeted nasal decolonization did not significantly reduce the risk of multidrug-resistant infections in the overall non–critically ill patient population, but large reductions were seen in the subset of patients with medical devices.

Implementing a targeted intervention (for example, by identifying select inpatients with medical devices) can be challenging. Targeted interventions often require dedicated information technology support in the form of targeted order sets and adherence reports for project champions to track and encourage uptake. For this reason, NIH requested that AHRQ support a tool kit to disseminate the results of the ABATE Infection trial. The tool kit is available online and provides:

• Decision-making and preparatory steps
• Protocols
• Handouts
• Training documents and videos
• Adherence and skills assessment checklists
• Responses to frequently asked questions

PRIM-ER

PRIM-ER, an NIH Collaboratory Trial, was a stepped-wedge, cluster randomized trial of a palliative care training program in emergency departments in the United States. The program consisted of training in palliative care, simulation-based communication workshops, clinical decision support tools, and audit and feedback to promote evidence-based opioid prescribing in emergency departments. The trial leveraged existing EHR systems to implement opioid prescribing guidelines, decision support, and education across diverse healthcare systems. The findings were translated into actionable prescribing strategies that could be rapidly adopted across emergency care settings, influencing both local workflows and national discussions on safer opioid prescribing.

STOP CRC

STOP CRC, an NIH Collaboratory Trial, was a cluster randomized trial in 26 federally qualified health center clinics in 8 health centers in Oregon and California with participants who were overdue for colorectal cancer screening. The intervention involved embedding a tool in the EHR to identify patients who were overdue for screening, mailing a fecal immunochemical test (FIT) kit and reminder letter to these patients, and implementing a practice improvement process at the clinics. The outreach program improved rates of colorectal cancer screening, and successful implementation was correlated with higher rates of FIT completion.

Dissemination activities for STOP CRC included a website of resources for patients and clinicians with program materials, an implementation guide describing the mailed FIT program and how to orient a clinic to the program, and how-to guides for patients about preparing for colonoscopy and understanding the results. Clinics that implement the program need to address technical, workflow, and policy questions before launching it. The implementation guide for clinics was based on lessons from a workshop on fundamental concepts of communications planning led by members of AcademyHealth’s communications team.