Using Learning Teams for Reflective Adaptation for Diabetes

描述(由申请人提供)： 基于证据的糖尿病初级保健指南已经建立和传播，但在社区初级保健实践中采用指南一直令人失望。这项有效性研究提出了一项随机试验，涉及24个基于社区的初级保健实践，以测试一种改善糖尿病护理的创新干预措施。这项干预源于在其他环境中经过测试的理论基础和有效计划，采用了广泛的重点，并寻求通过a)增加实践的组织能力来管理变化，以及b)实施和维持支持临床医生努力改善糖尿病护理的慢性护理办公室系统来改善糖尿病护理。干预将结合两个综合组成部分。第一个组成部分将利用一名改进促进者，评估该做法目前对慢性护理办公室系统的使用及其管理变化的组织能力，向实践中的关键利益相关者提供反馈，并在六个月内与该做法合作，组成一个改进小组，该小组将处理创建和维持改善以及实施糖尿病慢性护理系统的组织能力。在干预措施的第二部分，该做法将参加一个地方改进合作项目，该项目将提供机会，在干预措施的实施和维护阶段与其所在地理区域的三个类似做法学习和分享经验。干预措施将通过两种方式进行评估。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个次级终点，包括a)通过患者报告和审查医疗记录来衡量ADA医生认可计划的绩效，以及b)评估实践在糖尿病护理中实施和医生使用慢性护理模式要素的程度。从基线到12个月的变化将评估慢性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，以了解干预如何以及为什么导致观察到的效果。做法评估将努力了解干预措施的哪些部分最有效，它们的相对执行成本，以及如何进一步改进它们。干预的成功组成部分将被改进，并提供给我们在该项目中的合作者；COPIC保险公司和科罗拉多州临床指南合作，用于他们在全州范围内改善糖尿病护理的活动。

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.