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

组织自我评估以改善初级保健实践中的糖尿病护理

基本信息

批准号：
7621012
负责人：
JESSE C CROSSON
金额：
$ 23.4万
依托单位：
UNIV OF MED/DENT OF NJ-NJ MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-05-15 至 2011-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7621012
关键词：
Address Adherence Adult Affect Caring Cause of Death Clinical Trials Data Data Collection Development Diabetes Mellitus Dyslipidemias Effectiveness Effectiveness of Interventions Environment Expenditure Family Practice Feasibility Studies Funding Guidelines Health Care Costs Hypertension Incidence Intervention Link Medical Care Team Medical Records Methods Modeling Monitor Morbidity - disease rate NIH Program Announcements National Institute of Diabetes and Digestive and Kidney Diseases New Jersey Non-Insulin-Dependent Diabetes Mellitus Organizational Change Outcome Ownership Patients Pennsylvania Performance Pilot Projects Population Prevention Research Primary Care Physician Primary Health Care Process Public Health Quality of Care Randomized Controlled Trials Recruitment Activity Registries Research Research Personnel Resources Rural Screening procedure Self Assessment Series Stress Structure System Testing Translating Work base control trial cost cost effectiveness diabetes control disease registry effective intervention evidence base experience follow-up improved instrument patient population primary care setting response suburb therapy design tool

项目摘要

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.

描述（由申请人提供）：问题：糖尿病是美国第五大死因，预计从 1995 年到 2025 年，发病率将增加 42%。糖尿病还会导致发病率上升，每年的总体费用估计为 1,320 亿美元。尽管大多数患有糖尿病的成年人都会向初级保健医生寻求治疗，但在这些环境中对糖尿病治疗指南的遵守情况仍然不够理想。基于初级保健实践变革 IMPACT 模型的质量改进干预措施提高了实践绩效。然而，实现这些改变所需的资源限制了将这些发现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：初级保健实践如何以经济有效的方式利用其现有能力来提高对糖尿病指南的遵守率？目的：测试组织变革干预措施的可行性，该干预措施旨在通过提高实践水平的自我理解来提高初级保健中循证糖尿病治疗指南的依从性。方法：我们采用了一系列资助研究中开发的工具，用于实践自我评估。六家初级保健机构将使用这些工具来评估现有的糖尿病护理流程。实践将使用组织自我评估结果来指导疾病登记册的开发，并将登记册的使用整合到现有工作流程中，以改进与中间结果紧密相关的护理流程。现场研究人员将收集有关干预措施的可行性、与注册管理机构开发和使用过程相关的费用以及自我评估过程的保真度的定性和定量数据。我们将通过病历审查来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小组随机对照试验的开发提供信息。益处：这项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因，每年糖尿病护理费用估计为 1,320 亿美元。尽管大多数患有糖尿病的成年人都会向初级保健医生寻求治疗，但在这些环境中对糖尿病治疗指南的遵守情况仍然不够理想。我们建议在六种初级保健实践中测试低成本组织变革干预措施的可行性，该干预措施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依从性。