Evaluating a Patient-Centered Diabetes Registry

描述(申请人提供)：初级保健临床医生负责提供很大比例的慢性病护理，但在这些环境中，采用新的慢性护理模式的速度一直很慢。一些初级保健做法使用疾病登记处来识别和跟踪慢性病患者，但很少收集和跟踪临床数据来监测和/或改进做法。为了实现改进的慢性护理系统的好处，登记处必须在繁忙的初级保健办公室变得更容易使用和维持。信息技术提供了使疾病登记的许多功能自动化并提高其可行性的能力。此外，通过将登记处的使用范围扩大到初级保健实践之外，将慢性病护理团队的另一个重要成员：患者包括在内，可以提高登记处的有效性。这一拟议项目的目的是研究实施以患者为中心的登记的可行性，以改善初级保健中的糖尿病护理。与典型的被动式糖尿病登记处不同，我们只监测临床医生发起的服务，我们将测试双向登记处，患者和诊所都可以在其中输入数据，并接收关于符合指南的糖尿病护理和自我管理的定制信息。提出了一个多步骤转化性研究框架，以指导对干预措施的测试、实施和持续评估。首先，我们将让“终端用户”(患者、临床医生和临床支持人员/管理人员)参与我们以患者为中心的糖尿病登记系统的可用性测试。其次，我们将使用循证程序在初级保健实践中规划和实施以患者为中心的登记，并制定旨在加强接受、采用和实施的战略。最后，使用参与式研究方法，我们将与初级保健实践密切合作，不断学习和改进。使用RE-AIM框架，我们的评估旨在研究以患者为中心的注册表开发和测试的所有阶段的覆盖范围、有效性、采用和实施。该项目的结果将为一项全面的随机对照试验奠定基础，以研究以患者为中心的糖尿病登记在不同的诊所、临床医生和糖尿病患者中的有效性。

DESCRIPTION (Provided by Applicant): Primary care clinicians are responsible for delivering a large percentage of chronic illness care, yet adoption of new models of chronic care has been slow in these settings. Some primary care practices use disease registries to identify and track patients with chronic disease, but few collect and track clinical data to monitor and/or improve practice. To realize the benefits of an improved system of chronic care, registries must become easier to use and sustain in busy primary care offices. Information technology offers the ability to automate many of the functions of a disease registry and improve its feasibility. Also, the effectiveness of registries might be enhanced by expanding their use beyond the primary care practice to include another important member of the chronic care team: the patient. The purpose of this proposed project is to study the feasibility of implementing a patient-centered registry for improving diabetes care in primary care. Unlike typical, passive diabetes registries designed to monitor only those services initiated by clinicians, we will test a bi-directional registry where both patients and practices can enter data and receive tailored information about guideline-concordant diabetes care and self-management. A multi-step translational research framework is proposed to guide testing, implementation, and ongoing evaluation of the intervention. First, we will involve "end-users" (patients, clinicians, and clinic support staff/administration) in usability testing of our patient-centered diabetes registry. Second, we will use evidence-informed processes for planning and implementing this patient-centered registry within primary care practices, with strategies designed to enhance acceptance, adoption and implementation. Finally, using a participatory research approach, we will work closely with primary care practices in ongoing learning and improvement. Using the RE-AIM framework, our evaluation is designed to study reach, effectiveness, adoption and implementation during all phases of developing and testing the patient-centered registry. Results from this project will set the stage for a full-scale randomized controlled trial to study the effectiveness of a patient-centered diabetes registry across diverse practices, clinicians and people with diabetes.