Organizational Self-Assessment to Improve Diabetes Care in Primary Care Practices

描述（由申请人提供）： 问题：糖尿病是美国第五大死亡原因，预计从1995年到2025年发病率将增加42%。糖尿病还导致发病率增加，估计每年的总费用为1320亿美元。虽然大多数糖尿病患者从初级保健医生那里寻求护理，但在这些环境中遵守糖尿病治疗指南仍然不是最佳的。基于IMPACT模式的初级保健实践变化的质量改进干预措施，导致实践绩效的提高。然而，实现这些变化所需的资源限制了将这些研究结果转化为财政紧张的初级保健环境的可能性。我们将解决这个问题：初级保健实践如何有效地利用其现有能力来提高对糖尿病指南的依从性？目的：旨在通过提高实践层面的自我理解，测试组织变革干预的可行性，以提高对循证糖尿病治疗指南的依从性。方法：我们已经适应了在一系列资助的研究中开发的工具，用于实践自我评估。六个初级保健实践将使用这些工具来评估现有的糖尿病护理过程。实践将使用组织的自我评估结果来指导疾病登记的发展，并将登记的使用纳入现有的工作流程，以改善与中间结果密切相关的护理过程。一名实地研究人员将收集关于干预措施可行性、与登记册开发和使用过程有关的费用以及关于自我评估过程的真实性的定性和定量数据。我们将通过病历审查评估干预前后的糖尿病护理质量。结果：可行性研究数据的分析将为干预措施的分组随机对照试验的发展提供信息。受益：本研究的结果将用于开发具有成本效益的方法，以改善初级保健实践中的糖尿病护理。 糖尿病是美国第五大死亡原因，每年的糖尿病护理费用估计为1320亿美元。虽然大多数糖尿病患者从初级保健医生那里寻求护理，但在这些环境中遵守糖尿病治疗指南仍然不是最佳的。我们建议测试，在六个初级保健的做法，低成本的组织变革干预的可行性，旨在提高遵守循证糖尿病治疗指南，提高实践水平的自我理解。

DESCRIPTION (provided by applicant): Problem: Diabetes is the fifth leading cause of death in the US and is predicted to increase in incidence by 42% from 1995 to 2025. Diabetes also contributes to increased rates of morbidity with overall estimated costs of $132 billion annually. Although most adults with diabetes seek their care from primary care physicians, adherence to diabetes treatment guidelines in these settings remains less than optimal. Quality improvement interventions based on the IMPACT model of primary care practice change have led to improved practice performance. However, the resources needed to accomplish these changes limit the possibility of translating these findings into the financially stressed primary care environment. We will address the question: How can primary care practices use their existing capacities cost-effectively to improve adherence to diabetes guidelines? Purpose: To test the feasibility of an organizational change intervention designed to improve adherence to evidence-based diabetes treatment guidelines in primary care by improving practice-level self understanding. Methods: We have adapted instruments developed in a series of funded studies for use in practice self-assessment. Six primary care practices will use these tools to assess existing diabetes care processes. Practices will use the organizational self-assessment findings to direct the development of a disease registry and integrate the use of the registry into existing workflow to improve processes of care that are tightly linked to intermediate outcomes. A field researcher will collect qualitative and quantitative data on the feasibility of the intervention, expenses associated with the process of registry development and use, and on the fidelity of the self-assessment process. We will assess diabetes care quality before and after the intervention through medical record review. Outcomes: Analysis of the feasibility study data will inform the development of a group randomized controlled trial of the intervention. Benefit: Findings from this study will be used to develop cost-effective methods for improving diabetes care in primary care practices. Diabetes is the fifth leading cause of death in the US and the costs of diabetes care are estimated at $132 billion annually. Although most adults with diabetes seek their care from primary care physicians, adherence to diabetes treatment guidelines in these settings remains less than optimal. We propose to test, in six primary care practices, the feasibility of a low cost organizational change intervention designed to improve adherence to evidence-based diabetes treatment guidelines by improving practice level self understanding.