Redesigning Diabetes Work Processes for Population-based Primary Care

描述（由申请人提供）：问题：糖尿病是美国第六大死亡原因，预计从1995年到2025年，发病率将增加42%。糖尿病还导致发病率上升，每年的总成本估计为1740亿美元。尽管大多数成年糖尿病患者向初级保健医生寻求治疗，但在这些情况下，遵守糖尿病治疗指南仍不是最佳选择。实践改进工作通常需要大量的实践和外部资源，因此限制了将这些改进转化为财政紧张的初级保健环境的潜力。我们将探讨以下问题：初级保健实践是否可以使用低成本的多方面组织变革过程来提高对糖尿病指南的依从性？目的：评估以糖尿病登记采用为重点的多方面组织变革干预的有效性和成本效益，以提高初级保健中糖尿病护理的质量。方法：基于我们成功的糖尿病登记实施R34试点研究，我们将在30个初级保健实践中进行一项干预措施的组随机对照临床试验。参与的初级保健实践将进行组织自我评估，并利用这一过程的结果来指导疾病登记的实施和使用。实践负责人将接受关于人口健康糖尿病护理方法的简短教育，并在规划工作流程变化和必要的基本技术支持方面获得有限的支持。我们将使用在R34试验中改进的方法和仪器来收集患者水平的结果数据并记录干预成本。结果：在整个项目中，我们将通过基线和定期的医疗记录审查来评估糖尿病护理质量。我们将通过观察和干预活动的实践日志收集干预成本数据，以便对干预进行成本效益评估。一项多方面的定性过程评估将记录干预措施的实施情况，并详细了解与实施和持续使用糖尿病患者护理登记册相关的因素。益处：本研究的发现将有助于更好地理解如何利用现有的实践资源和关注改善初级保健实践中的糖尿病护理。

DESCRIPTION (provided by applicant): Problem: Diabetes is the sixth 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 $174 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. Practice improvement efforts typically require substantial practice and outside resources thus limiting the potential for translating these improvements into the financially stressed primary care environment. We will address the question: Can primary care practices use a low-cost multifaceted organizational change process to improve adherence to diabetes guidelines? Purpose: To evaluate the effectiveness and cost-effectiveness of a multi-faceted organizational change intervention focused on diabetes registry adoption for improving the quality of diabetes care in primary care. Methods: We will conduct a group-randomized controlled clinical trial in 30 primary care practices of an intervention based on our successful R34 pilot study of diabetes registry implementation. Participating primary care practices will conduct an organizational self-assessment and use findings from this process to direct the implementation and use of a disease registry. Practice leaders will receive brief education on population health approaches to diabetes care as well as limited support for planning work process changes and basic technical support as needed. We will use methods and instruments refined in the R34 pilot to collect patient-level outcomes data and document intervention costs. Outcomes: We will assess diabetes care quality through medical record review at baseline and at regular intervals throughout the project. We will collect intervention cost data through observation and practice logs of intervention activities in order to conduct a cost-effectiveness evaluation of the intervention. A multi-faceted qualitative process evaluation will document the intervention as delivered and provide a detailed understanding of the factors associated with implementation and sustained use of a diabetes patient care registry for dissemination. Benefit: Findings from this study will lead to a better understanding of how to leverage existing practice resources and concerns for improving diabetes care in primary care practices.