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: 7289895
• 负责人: David R. West
• 金额: $ 59.59万
• 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/7289895
• 关键词: Academic Detailing; Acute; Address; Adopted; Adoption; Belief; Blood Glucose; Blood Pressure; Caring; Characteristics; Chronic; Chronic Care; Chronic Disease; Classification; Clinical; Clinical Management; Clinical Trials; Colorado; Communities; Condition; Data; Depth; Diabetes Mellitus; Disease; Effectiveness; Elements; End Point; Environment; Feedback; Geographic Locations; Guidelines; Health system; Healthcare; Human Resources; Individual; Insurance; Intervention; Interview; Learning; Lip structure; Lipids; Maintenance; Measurement; Measures; Medical Records; Metabolic; Methods; Modeling; Morbidity - disease rate; Nature; Non-Insulin-Dependent Diabetes Mellitus; Numbers; Operative Surgical Procedures; Outcome; Patient Care; Patients; Performance; Phase; Physicians; Physiological; Population; Preparation; Primary Care Physician; Primary Health Care; Procedures; Process; Process Assessment; Randomized; Randomized Controlled Clinical Trials; Range; Recommendation; Relative (related person); Reporting; Research; Research Personnel; Resources; Self Management; Services; Stress; Support System; Surveys; System; Testing; Translations; Visit; Work; base; chronic care model; cost; design; evidence based guidelines; experience; improved; innovation; mortality; patient oriented; prevent; programs; prospective; sound; success

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）： 糖尿病初级保健循证指南已经建立和传播，但在社区为基础的初级保健实践中采用的指南一直令人失望。这项有效性研究提出了一项随机试验，涉及24个以社区为基础的初级保健实践，以测试一种创新的干预措施，以改善糖尿病护理。干预措施，从理论上为基础的和有效的程序在其他环境中进行了测试，采用了广泛的重点，并寻求改善糖尿病护理a）提高实践的组织能力，以管理变化，和B）实施和维持慢性病护理办公室系统，支持临床医生的努力，以改善糖尿病护理。干预措施将结合联合收割机两个综合组成部分。第一个组成部分将利用一个改进促进者，将评估实践的慢性病护理办公室系统的当前使用情况及其管理变革的组织能力，向实践中的关键利益相关者提供反馈，并与实践合作六个月以上，以形成一个改进团队，该团队将解决创建和维持改进的组织能力，并实施糖尿病慢性病护理系统。在干预措施的第二个组成部分，实践将参与当地的改进协作，这将提供机会，在实施和维护阶段的干预措施与三个类似的做法在他们的地理区域学习和分享经验。干预措施将以两种方式进行评估。首先，一项采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的ADA医生认可计划绩效指标，以及B）评估实践实施程度和医生在糖尿病护理中使用慢性护理模式要素的程度。从基线到12个月的变化将评估长期护理改善的采用情况，从12个月到24个月的变化将评估改善的可持续性。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什么会产生观察到的效果。实践评估将努力了解干预措施的哪些组成部分最有效，其相对执行成本，以及如何进一步改进。干预的成功组成部分将得到完善，并提供给我们在该项目中的合作者;科普克保险公司和科罗拉多临床指南合作，用于他们在全州范围内的活动，以改善糖尿病护理。