Using Practice Facilitation and Operationalizing Referral Information Technology (UP FOR IT) to Increase DSMES Utilization

项目摘要 肯塔基州的糖尿病患病率比全国平均水平高出约25%， 肯塔基州面临着更高的糖尿病及其相关并发症的负担。糖尿病自我管理 糖尿病教育和支持（DSMES）服务是高质量糖尿病护理不可或缺的一部分。大量证据表明， DSMES的参与改善了糖尿病的结果，并且具有成本效益。尽管有强有力的证据表明， 美国糖尿病协会的明确指南推荐使用，<10%的合格个体 完整的DSMES。导致DSMES吸收率低的决定因素存在于多个层面，包括 临床医生意识、地理可用性、成本和报销以及转诊机制。虽然 肯塔基州公共卫生部管理着一个全州范围的DSMES项目，该项目对参与者免费， 在80/120个县中，通过面对面和所有县的远程保健，DSMES的利用率仍然很低 横跨肯塔基州。针对目前的RFA寻求测试创新和务实的方法， 促进更多地使用DSMES，我们建议测试和评估一个诊所级的干预， 卫生信息技术（自动化病人识别和双向转诊系统），以减少 与合格患者的识别和转诊相关的障碍，并使临床团队参与实践 促进合作，以提高临床医生的认识，克服临床水平的障碍。我们将实现这一目标 （1）规划-实施科学指导下的评价和调整现有试点项目 糖尿病临床质量改进计划; 2）实施-适应性干预;和3） 评价-采用切实、有力的执行和可持续性模式对干预措施的组成部分进行评价 （PRISM）.我们将根据一个成功的试点项目，利用健康信息， 技术和协作质量改进方法，以提高DSMES在参与 诊所> 100%。我们将使用一个务实的集群随机研究设计，以评估实施 有效性，并将使用执行科学框架来指导可行性评价， 可接受性和可持续性。为达致研究目的，我们与 肯塔基州公共卫生部（DSMES提供商）、肯塔基州区域推广合作组织 （实践促进合作伙伴），肯塔基州健康信息交换（健康信息技术合作伙伴） 以及肯塔基州农村的两个医疗系统。这一试点和可行性研究将提供务实的见解， 可扩展和可持续的战略，以提高DSMES的利用率。调查结果将产生关键的初步数据 这将指导R 01级传播和实施试验的规划， 与糖尿病有关的发病率和死亡率。

PROJECT SUMMARY The prevalence of diabetes in Kentucky is ~25% higher than the national average, and rural areas within Kentucky face an even higher burden of diabetes and its related complications. Diabetes self-management education and support (DSMES) services are integral to quality diabetes care. Substantial evidence shows that DSMES participation improves diabetes outcomes and is cost-effective. Despite strong evidence of benefit and clear guidelines from the American Diabetes Association recommending its use, <10% of eligible individuals complete DSMES. Determinants that contribute to low DSMES uptake exist at multiple levels and include clinician awareness, geographic availability, cost and reimbursement, and referral mechanisms. Although the Kentucky Department of Public Health administers a statewide DSMES program that is free to participants and available face-to-face in 80/120 counties and by telehealth in all counties, DSMES utilization remains low across Kentucky. In response to the current RFA seeking to test innovative and pragmatic approaches to facilitate greater use of DSMES, we propose testing and evaluating a clinic-level intervention that implements health information technology (automated patient identification and a bidirectional referral system) to reduce barriers related to identification and referral of eligible patients and engages clinical teams in a practice facilitation collaborative to increase clinician awareness and overcome clinic-level barriers. We will achieve this through three aims: 1) Planning – implementation science-guided evaluation and adaptation of an existing pilot diabetes clinical quality improvement program; 2) Implementation – of the adapted intervention; and 3) Evaluation - of intervention components using the Practical, Robust Implementation and Sustainability Model (PRISM). We will adapt the proposed intervention from a successful pilot project that used health information technology and a collaborative quality improvement approach to increase DSMES utilization at participating clinics by >100%. We will use a pragmatic cluster randomized study design to evaluate implementation effectiveness and will use an implementation science framework to guide evaluation of the feasibility, acceptability, and sustainability of the intervention. To achieve the study aims, we have partnered with the Kentucky Department of Public Health (DSMES provider), the Kentucky Regional Extension Cooperative (practice facilitation partner), Kentucky Health Information Exchange (health information technology partner) and two healthcare systems in rural Kentucky. This pilot and feasibility study will provide insight on pragmatic, scalable, and sustainable strategies to increase DSMES utilization. Findings will generate key preliminary data that will guide planning of an R01-level dissemination and implementation trial with the goal of reducing diabetes-related morbidity and mortality.