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，糖尿病的发病率将增加42%。糖尿病还增加了发病率，每年的总成本估计为1320亿美元。尽管大多数成人糖尿病患者寻求初级保健医生的护理，但在这些情况下遵守糖尿病治疗指南仍然不是最理想的。基于初级保健实践变更影响模型的质量改进干预措施导致了实践绩效的改善。然而，完成这些改变所需的资源限制了将这些发现转化为经济压力较大的初级保健环境的可能性。我们将解决这个问题：初级保健实践如何以具有成本效益的方式利用其现有能力来改善对糖尿病指南的遵守？目的：测试组织变革干预的可行性，旨在通过提高实践水平的自我理解来提高初级保健中对循证糖尿病治疗指南的遵从性。方法：我们采用了在一系列基金研究中开发的工具，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流程。实践将利用组织的自我评估结果来指导疾病登记册的发展，并将登记册的使用纳入现有工作流程，以改进与中间成果密切相关的护理过程。一名外地研究人员将收集关于干预的可行性、与登记册开发和使用进程有关的费用以及自我评估进程的忠实性的定性和定量数据。我们将通过查阅病历评估干预前后的糖尿病护理质量。结果：对可行性研究数据的分析将为干预的团体随机对照试验的发展提供信息。好处：这项研究的结果将被用来开发在初级保健实践中改善糖尿病护理的成本效益方法。 糖尿病是美国第五大死亡原因，糖尿病护理费用估计为每年1320亿美元。尽管大多数成人糖尿病患者寻求初级保健医生的护理，但在这些情况下遵守糖尿病治疗指南仍然不是最理想的。我们建议在六个初级保健实践中测试低成本组织变革干预的可行性，旨在通过提高实践水平的自我理解来提高对循证糖尿病治疗指南的遵从性。

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.