Using Learning Teams for Reflective Adaptation for Diabetes

利用学习团队进行糖尿病的反思性适应

• 批准号: 7121945
• 负责人: PAUL A NUTTING
• 金额: $ 70.38万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-15 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7121945
• 关键词: behavioral /social science research tag; clinical research; clinical trials; data collection methodology /evaluation; diabetes mellitus therapy; extended care; health care model; health care personnel; health care policy; health care professional practice; health care service evaluation; health care service planning; health service demonstration project; health services research tag; interview; longitudinal human study; noninsulin dependent diabetes mellitus; patient care management; patient oriented research; primary care physician

DESCRIPTION (provided by applicant): Evidence-based guidelines for primary care of diabetes have been established and disseminated, yet adoption of guidelines in community-based primary care practice has been disappointing. This effectiveness study proposes a randomized trial involving 24 community-based primary care practices to test an innovative intervention to improve diabetes care. The intervention, derived from theoretically based and efficacious programs tested in other settings, adopts a broad focus and seeks to improve diabetes care by a) increasing the practice's organizational capacity to manage change, and b) implementing and sustaining chronic care office systems that support clinician efforts to improve care for diabetes. The intervention will combine two integrated components. The first component will utilize an Improvement Facilitator that will assess the practice's current use of chronic care office systems and their organizational capacity to manage change, provide feedback to key stakeholders in the practice, and work with the practice over six months to form an Improvement Team that will both address organizational capacity to create and sustain improvement and implement chronic care systems for diabetes. In the second component of the intervention, the practice will participate in a local Improvement Collaborative that will afford opportunities to learn and share experiences during implementation and maintenance phases of the intervention with three similar practices in their geographic area. The intervention will be evaluated in two ways. First, a randomized trial using rigorous quantitative methods will measure 2 primary and 3 secondary endpoints at 12 and 24 months, including a) the ADA Physician Recognition Program performance measures by both patient-report and review of the medical record, and b) assessment of the extent to which practices implement and physicians use elements of the chronic care model in their care of diabetes. Change from baseline to 12 months will assess adoption of chronic care improvements, and change from 12 to 24 months will assess sustainability of improvements. Second, a multimethod assessment process will be used to analyze all qualitative and quantitative data separately to understand how and why the intervention led to the observed effects. The practice assessment will strive to understand which components of the interventions were most effective, their relative costs for implementation, and how they might be further improved. Successful components of the intervention will be refined and made available to our collaborators in the project; the Copic Insurance Company and the Colorado Clinical Guidelines Collaborative, for use in their statewide activities to improve diabetes care.

描述（由申请人提供）： 糖尿病初级保健的循证指南已经制定并传播，但社区初级保健实践中指南的采用却令人失望。这项有效性研究提出了一项涉及 24 个社区初级保健实践的随机试验，以测试改善糖尿病护理的创新干预措施。该干预措施源自在其他环境中测试的基于理论的有效计划，采用广泛的重点，并寻求通过以下方式改善糖尿病护理：a）提高实践管理变革的组织能力；b）实施和维持长期护理办公室系统，支持临床医生改善糖尿病护理的努力。该干预措施将结合两个集成部分。第一个组成部分将利用改进协调员，评估诊所目前对慢性护理办公系统的使用情况及其管理变革的组织能力，向诊所中的主要利益相关者提供反馈，并在六个月内与诊所合作组建一个改进团队，该团队将解决创建和维持改进以及实施糖尿病慢性护理系统的组织能力。在干预措施的第二个组成部分中，实践将参加当地的改进合作组织，该合作组织将提供在干预措施的实施和维护阶段与其地理区域内的三个类似实践学习和分享经验的机会。干预措施将以两种方式进行评估。首先，使用严格定量方法的随机试验将在 12 个月和 24 个月时测量 2 个主要终点和 3 个次要终点，包括 a) 通过患者报告和病历审查来衡量 ADA 医师认可计划绩效，以及 b) 评估在糖尿病护理中实践实施和医生使用慢性护理模式要素的程度。从基线改为 12 个月将评估慢性病护理改进的采用情况，从 12 个月改为 24 个月将评估改进的可持续性。其次，将使用多方法评估过程来分别分析所有定性和定量数据，以了解干预措施如何以及为何导致观察到的效果。实践评估将努力了解干预措施的哪些组成部分最有效、实施的相对成本以及如何进一步改进。干预措施的成功组成部分将得到完善，并提供给我们项目中的合作者； Copic 保险公司和科罗拉多州临床指南合作组织，用于其全州范围内改善糖尿病护理的活动。