Redesigning Diabetes Work Processes for Population-Based Primary Care

描述（由申请人提供）：问题：糖尿病是美国第七大死亡原因，预计从1995年到2025年发病率将增加42%。糖尿病还导致发病率增加，估计每年的总费用为1740亿美元。虽然大多数糖尿病患者从初级保健医生那里寻求护理，但在这些环境中遵守糖尿病治疗指南仍然不是最佳的。实践改进工作通常需要大量的实践和外部资源，从而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。我们将解决这个问题：初级保健的做法可以使用低成本的多方面的组织变革过程，以提高遵守糖尿病指南？目的：评价多方面组织变革干预的有效性和成本效益，重点是糖尿病登记采用，以提高初级保健中糖尿病护理的质量。研究方法：我们将在30个初级保健实践中进行一项分组随机对照临床试验，该试验基于我们成功的糖尿病注册实施的R34试点研究。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。实践领导者将接受关于糖尿病护理的人口健康方法的简短教育，以及对规划工作流程变化的有限支持和必要的基本技术支持。我们将使用R34试点中完善的方法和工具来收集患者水平的结果数据并记录干预成本。结果：我们将通过基线和整个项目期间定期的病历审查来评估糖尿病护理质量。我们会透过介入活动的观察及实践日志收集介入成本数据，以进行介入的成本效益评估。一个多方面的定性过程评估将记录所提供的干预措施，并提供与实施和持续使用糖尿病患者护理登记册传播相关的因素的详细了解。优点：这项研究的结果将使我们更好地了解如何利用现有的实践资源和关注，以改善初级保健实践中的糖尿病护理。

DESCRIPTION (provided by applicant): Problem: Diabetes is the seventh 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.