A randomized trial to implement practice recommendations: Design and methods of the Dementia Care Study

The objective of the Dementia Care Study was to design, implement, and eval uate, in a randomized controlled trial a multi-faceted, specialty-society s ponsored intervention to encourage neurologists' adoption of practice recom mendations. Eligible participants were 417 neurologists in six regions in N ew York State (NYS) who were identified through the American Academy of Neu rology (AAN) Membership Database and the NYS Physician Masterfile. An Advis ory Panel of experts on dementia, neurologists who were local opinion leade rs, and local representatives of the Alzheimer's Association guided the dev elopment of the intervention. The intervention included six components: (1) a mailing of six practice recommendations in a course of continuing medica l education (CME) sponsored by the AAN; (2) a mailing of supplementary, pra ctice-based tools; (3) follow-up mailings reinforcing the recommendations; (4) an invitation to an AAN-sponsored seminar; (5) endorsement by opinion l eaders; and (6) specialty-society sponsorship and endorsement. The primary outcome measure was neurologists' decisionmaking; as assessed through a mai led survey that used detailed clinical scenarios. intervention and control neurologists received the survey six months after the intervention, and a b aseline group received it three months prior to the intervention. To evalua te the concordance of responses to scenarios with actual processes of care, we reviewed medical records in one study region. Secondary outcome measure s included number of patient referrals received by the local Alzheimer's As sociations and by the Association's National Safe Return Program. The speci alty society, the opinion leaders, the dementia experts, local advocacy gro ups, and the study investigators achieved a high degree of collaboration. S pecialty societies can integrate within their educational programs the capa bility to design and evaluate the impact of novel strategies to encourage t he adoption of practice recommendations that are linked to improved quality of care. Control Clin Trials 1999;20:369-385 (C) Elsevier Science Inc. 199 9.