# Combining Policy and Implementation Science to Optimize Clinical Practice

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $623,348

## Abstract

PROJECT SUMMARY ABSTRACT: Changing clinician practice is difficult but important. Traditionally,
strategies to attain sustainable practice change have followed one of two general paths: financial incentives
and practice redesign and implementation. Financial incentives, while often effective in aggregate, tend to have
heterogeneous effects across individuals and systems. Practice design and implementation, while allowing for
highly tailored local solutions, is resource intensive and thus difficult to scale across settings and populations.
We hypothesize that the two strategies can be deployed together, augmenting their respective strengths and
mitigating their weaknesses. The Principal Investigator, in her ongoing K08-award, identified preoperative
patient optimization as an ideal case study for new models effecting clinician practice change. Adherence to
best practices that manage obesity, smoking, and diabetes preoperatively can reduce surgical complications
by up to 40%. Despite the compelling clinical case, surgeon adherence to preoperative patient optimization
remains surprisingly low. Her work highlighted the most important barriers to surgeon adherence. First,
surgeons have little financial incentive to delay surgery, suggesting the potential for financial incentives to
quickly align surgeon practices with patient preoperative optimization. Second, barriers related to resources for
patient optimization, organizational culture, and established practice patterns were identified; highlighting the
need for additional behavior change strategies such as a clinician facing educational and behavior change
intervention PREoperative Program (PREP) and onsite facilitation to overcome organizational and practice
barriers. This proposal builds on these K08 findings to deploy and test a novel combination of: 1) a policy
creating a financial incentive (policy evaluation) with 2) implementation science strategies (by adding these
resources to policy non-responders) to create an effective and scalable program to improve practice. The
project will leverage the Michigan Surgical Quality Collaborative (MSQC), a well-established, statewide registry
and improvement consortium involving 70 hospitals in Michigan. We will take advantage of a unique
opportunity to conduct a natural experiment of a recently launched pay-for-performance (P4P) program (Aim 1)
combined with a non-responder Sequential Multiple Assignment Randomized Trial (SMART) trial (Aims 2 and
3) to test the effectiveness of PREP and an onsite facilitator on augmenting site underperformance or non-
response to the P4P incentive. The SMART design allows for testing a strategy of applying higher resource
intervention only when the change was not facilitated with a lower resource intervention, explicitly recognizing
the trade-off between resource intensity and scalability. The proposed study will have immediate and
significant impact by developing and validating optimal strategies for improving adherenc...

## Key facts

- **NIH application ID:** 10815724
- **Project number:** 5R01DK128179-03
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Dana Alexa Telem
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $623,348
- **Award type:** 5
- **Project period:** 2022-04-15 → 2027-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10815724

## Citation

> US National Institutes of Health, RePORTER application 10815724, Combining Policy and Implementation Science to Optimize Clinical Practice (5R01DK128179-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10815724. Licensed CC0.

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