Using Practice Facilitation and Operationalizing Referral Information Technology (UP FOR IT) to Increase DSMES Utilization

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PROJECT SUMMARY The prevalence of diabetes in Kentucky is ~25% higher than the national average, and rural areas within Kentucky face an even higher burden of diabetes and its related complications. Diabetes self-management education and support (DSMES) services are integral to quality diabetes care. Substantial evidence shows that DSMES participation improves diabetes outcomes and is cost-effective. Despite strong evidence of benefit and clear guidelines from the American Diabetes Association recommending its use, <10% of eligible individuals complete DSMES. Determinants that contribute to low DSMES uptake exist at multiple levels and include clinician awareness, geographic availability, cost and reimbursement, and referral mechanisms. Although the Kentucky Department of Public Health administers a statewide DSMES program that is free to participants and available face-to-face in 80/120 counties and by telehealth in all counties, DSMES utilization remains low across Kentucky. In response to the current RFA seeking to test innovative and pragmatic approaches to facilitate greater use of DSMES, we propose testing and evaluating a clinic-level intervention that implements health information technology (automated patient identification and a bidirectional referral system) to reduce barriers related to identification and referral of eligible patients and engages clinical teams in a practice facilitation collaborative to increase clinician awareness and overcome clinic-level barriers. We will achieve this through three aims: 1) Planning – implementation science-guided evaluation and adaptation of an existing pilot diabetes clinical quality improvement program; 2) Implementation – of the adapted intervention; and 3) Evaluation - of intervention components using the Practical, Robust Implementation and Sustainability Model (PRISM). We will adapt the proposed intervention from a successful pilot project that used health information technology and a collaborative quality improvement approach to increase DSMES utilization at participating clinics by >100%. We will use a pragmatic cluster randomized study design to evaluate implementation effectiveness and will use an implementation science framework to guide evaluation of the feasibility, acceptability, and sustainability of the intervention. To achieve the study aims, we have partnered with the Kentucky Department of Public Health (DSMES provider), the Kentucky Regional Extension Cooperative (practice facilitation partner), Kentucky Health Information Exchange (health information technology partner) and two healthcare systems in rural Kentucky. This pilot and feasibility study will provide insight on pragmatic, scalable, and sustainable strategies to increase DSMES utilization. Findings will generate key preliminary data that will guide planning of an R01-level dissemination and implementation trial with the goal of reducing diabetes-related morbidity and mortality.