Evaluating a Patient-Centered Diabetes Registry

描述（由申请人提供）：初级保健临床医生负责提供很大比例的慢性病护理，但在这些环境中采用新的慢性病护理模式一直很缓慢。一些初级保健实践使用疾病登记来识别和跟踪慢性病患者，但很少收集和跟踪临床数据来监测和/或改善实践。为了实现改善慢性病护理系统的好处，登记处必须在忙碌的初级保健办公室中变得更容易使用和维持。信息技术提供了使疾病登记处的许多功能自动化并提高其可行性的能力。此外，登记的有效性可能会提高扩大其使用范围以外的初级保健实践，包括另一个重要成员的长期护理团队：病人。本项目的目的是研究实施以患者为中心的登记制度的可行性，以改善初级保健中的糖尿病护理。与典型的被动糖尿病登记系统不同，该系统旨在仅监测临床医生启动的服务，我们将测试一个双向登记系统，患者和实践都可以输入数据并接收有关指南一致的糖尿病护理和自我管理的定制信息。一个多步骤的转化研究框架，提出了指导测试，实施和正在进行的评估干预。首先，我们将让“最终用户”（患者、临床医生和诊所支持人员/管理人员）参与我们以患者为中心的糖尿病登记处的可用性测试。第二，我们将使用循证流程在初级保健实践中规划和实施以患者为中心的登记，并制定旨在提高接受度，采用和实施的策略。最后，使用参与式研究方法，我们将与初级保健实践密切合作，不断学习和改进。使用RE-AIM框架，我们的评价旨在研究在开发和测试以患者为中心的登记研究的所有阶段的覆盖范围、有效性、采用和实施。该项目的结果将为全面的随机对照试验奠定基础，以研究以患者为中心的糖尿病登记在不同实践，临床医生和糖尿病患者中的有效性。

DESCRIPTION (Provided by Applicant): Primary care clinicians are responsible for delivering a large percentage of chronic illness care, yet adoption of new models of chronic care has been slow in these settings. Some primary care practices use disease registries to identify and track patients with chronic disease, but few collect and track clinical data to monitor and/or improve practice. To realize the benefits of an improved system of chronic care, registries must become easier to use and sustain in busy primary care offices. Information technology offers the ability to automate many of the functions of a disease registry and improve its feasibility. Also, the effectiveness of registries might be enhanced by expanding their use beyond the primary care practice to include another important member of the chronic care team: the patient. The purpose of this proposed project is to study the feasibility of implementing a patient-centered registry for improving diabetes care in primary care. Unlike typical, passive diabetes registries designed to monitor only those services initiated by clinicians, we will test a bi-directional registry where both patients and practices can enter data and receive tailored information about guideline-concordant diabetes care and self-management. A multi-step translational research framework is proposed to guide testing, implementation, and ongoing evaluation of the intervention. First, we will involve "end-users" (patients, clinicians, and clinic support staff/administration) in usability testing of our patient-centered diabetes registry. Second, we will use evidence-informed processes for planning and implementing this patient-centered registry within primary care practices, with strategies designed to enhance acceptance, adoption and implementation. Finally, using a participatory research approach, we will work closely with primary care practices in ongoing learning and improvement. Using the RE-AIM framework, our evaluation is designed to study reach, effectiveness, adoption and implementation during all phases of developing and testing the patient-centered registry. Results from this project will set the stage for a full-scale randomized controlled trial to study the effectiveness of a patient-centered diabetes registry across diverse practices, clinicians and people with diabetes.