INTEGRATE-D: A pilot-test of implementation strategies to support integration of medical and psychosocial care for people with Type II Diabetes

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PROJECT SUMMARY In 2016, the American Diabetes Association (ADA) published its first-ever recommendations for integrating medical and psychosocial care (“integrated care”) for patients with Type II Diabetes Mellitus (DMII) and common mental and behavioral health (MH/BH) problems. This landmark achievement has the potential to greatly improve patient health. In the United States, 30 million people live with DMII, and the majority receive care in primary care settings. By implementing the ADA recommendations, primary care practices will help patients better manage their MH/BH needs, meet recommended goals for DMII management, and reduce the risk of adverse outcomes. To implement ADA recommendations, practices must develop new skills, mobilize treatment resources, identify care gaps, and adopt tools and processes that support systematic detection of MH/BH status. Making these recommendations a routine part of practice is a major change, and it is critical to understand how best to implement the ADA recommendations and test their effectiveness in the real world. The proposal builds on a series of prior studies to develop and pilot test a package of implementation strategies – called INTEGRATE-D – to support practices in implementing the ADA recommendations for integrated DMII care, which involves systematic screening for and treatment of psychosocial (e.g., depression) need. INTEGRATE-D combines the following evidence-based implementation strategies: (1) electronic health record (EHR)-based support – to help align EHR use with ADA recommendations and enable screening for depression, anxiety, diabetes distress, cognitive impairment, and self-management, and support identifying and tracking progress on patient treatments and goals; (2) Audit and feedback – which involves assisting practices in accessing clinically relevant, actionable data reports to inform measurement and identification of care gaps in DMII and behavioral health care; (3) Skill-building resources – including training on ADA- recommended care; and (4) Facilitation – to help implement the above strategies and the practice changes needed to align care with ADA recommendations. The study aims are: Aim 1: Refine the INTEGRATE-D intervention by incorporating preferences of stakeholders. In partnership with primary care key stakeholders and experts, compile and refine the package of implementation strategies in the INTEGRATE-D intervention. Aim 2: Demonstrate feasibility and acceptability. Conduct a mixed method, pre-post pilot comparing two practices that receive the INTEGRATE-D intervention to two control practices that receive training materials only. Based on pilot findings and input from experts and key stakeholders, we will refine INTEGRATE-D, and design a pragmatic practice-based trial to study its effectiveness, implementation and ability to spread among diverse practices.