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

使用实践促进和操作推荐信息技术 (UP FOR IT) 来提高 DSMES 利用率

• 批准号: 10436133
• 负责人: Mary E. Lacy
• 金额: $ 30.49万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10436133
• 关键词: Address; Adult; American; Appalachian Region; Awareness; Blood Glucose; Caring; Charge; Clinic; Clinical; Communities; Complications of Diabetes Mellitus; County; Data; Diabetes Mellitus; Diagnosis; Disease; Education; Effectiveness; Evaluation; Face; Feasibility Studies; Geography; Glycosylated hemoglobin A; Goals; Guidelines; Health; Health Care Costs; Health system; Healthcare Systems; Individual; Information Technology; Intervention; Interview; Kentucky; Morbidity - disease rate; Motivation; Outcome; Participant; Patients; Persons; Pilot Projects; Population; Practical Robust Implementation and Sustainability Model; Prevalence; Primary Health Care; Process; Provider; Public Health; Quality of life; Randomized; Research Design; Rural; Secure; Services; Surveys; System; Testing; base; care costs; combat; community clinic; cost; cost effective; diabetes self-management; dissemination trial; effectiveness testing; empowered; evidence base; glycemic control; health disparity populations; health information technology; implementation evaluation; implementation framework; implementation process; implementation science; implementation trial; improved; innovation; insight; mortality; program costs; programs; response; rural area; rural health disparities; skills; system-level barriers; telehealth; uptake

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.

项目概要 肯塔基州的糖尿病患病率比全国平均水平高约 25%，农村地区的糖尿病患病率比全国平均水平高出约 25%。 肯塔基州面临着更高的糖尿病及其相关并发症的负担。糖尿病自我管理 教育和支持 (DSMES) 服务是优质糖尿病护理不可或缺的一部分。大量证据表明 DSMES 的参与可以改善糖尿病的预后并且具有成本效益。尽管有强有力的证据表明有益和 美国糖尿病协会明确推荐其使用指南，<10% 的合格个人 完整的 DSMES。导致 DSMES 吸收率低的决定因素存在于多个层面，包括 临床医生意识、地理可用性、费用和报销以及转诊机制。虽然 肯塔基州公共卫生部负责管理全州范围内的 DSMES 计划，该计划免费向参与者和 在 80/120 个县提供面对面服务，并在所有县通过远程医疗提供服务，DSMES 利用率仍然很低 横跨肯塔基州。为了回应当前的 RFA 寻求测试创新和务实的方法 为了促进 DSMES 的更多使用，我们建议测试和评估临床级干预措施，该干预措施实施 健康信息技术（自动患者识别和双向转诊系统），以减少 与识别和转诊合格患者相关的障碍，并让临床团队参与实践 促进协作，以提高临床医生的意识并克服临床层面的障碍。我们将实现这一目标 通过三个目标： 1) 规划——实施科学指导的评估和现有试点的调整 糖尿病临床质量改进计划； 2) 实施——调整后的干预措施；和 3) 使用实用、稳健的实施和可持续性模型评估干预措施 （棱镜）。我们将从使用健康信息的成功试点项目中调整拟议的干预措施 技术和协作质量改进方法，以提高参与时的 DSMES 利用率 诊所>100%。我们将使用务实的整群随机研究设计来评估实施情况 有效性并将使用实施科学框架来指导可行性评估， 干预措施的可接受性和可持续性。为了实现研究目标，我们与 肯塔基州公共卫生部（DSMES 提供商）、肯塔基州区域推广合作社 （实践促进合作伙伴），肯塔基州健康信息交换（健康信息技术合作伙伴） 以及肯塔基州农村地区的两个医疗保健系统。这项试点和可行性研究将为务实、 提高 DSMES 利用率的可扩展且可持续的战略。调查结果将产生关键的初步数据 这将指导 R01 级传播和实施试验的规划，目标是减少 糖尿病相关的发病率和死亡率。