Evaluating a Patient-Centered Diabetes Registry

描述（由申请人提供）：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一直很慢。一些初级保健实践使用疾病登记来识别和跟踪慢性病患者，但很少收集和跟踪临床数据以监测和/或改进实践。为了实现改善慢性病护理系统的好处，在繁忙的初级保健办公室，登记处必须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，通过将登记的使用范围扩大到初级保健实践之外，包括慢性病护理团队的另一个重要成员：患者，可能会提高登记的有效性。本项目的目的是研究实施以患者为中心的登记以改善初级保健中的糖尿病护理的可行性。与典型的被动糖尿病登记不同，我们将测试一个双向登记，患者和实践都可以输入数据并接收关于指南一致的糖尿病护理和自我管理的定制信息。提出了一个多步骤的转化研究框架来指导干预的测试、实施和持续评估。首先，我们将让“最终用户”（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处的可用性测试。其次，我们将在初级保健实践中使用循证流程来规划和实施这种以患者为中心的登记，并制定旨在提高接受、采用和实施的策略。最后，采用参与式研究方法，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在开发和测试以患者为中心的登记处的各个阶段的覆盖范围、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实践、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.