Redesigning Diabetes Work Processes for Population-based Primary Care

描述(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%。糖尿病还增加了发病率，每年的总成本估计为1740亿美元。尽管大多数成人糖尿病患者寻求初级保健医生的护理，但在这些情况下遵守糖尿病治疗指南仍然不是最理想的。改进做法的努力通常需要大量的做法和外部资源，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。我们将解决这个问题：初级保健实践能否使用低成本、多方面的组织变革过程来改善对糖尿病指南的遵守？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措施的有效性和成本效益，以提高初级保健中的糖尿病护理质量。方法：我们将在我们成功的糖尿病登记实施R34试点研究的基础上，在30个初级保健实践中进行一项分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，并使用这一进程的结果来指导疾病登记的实施和使用。实践领导者将接受有关人口健康、糖尿病护理方法的简要教育，以及在规划、工作流程改变和必要时提供基本技术支持方面的有限支持。我们将使用R34试点中改进的方法和工具来收集患者级别的结果数据并记录干预成本。结果：在整个项目中，我们将通过在基线和定期间隔进行病历审查来评估糖尿病护理质量。我们将通过干预活动的观察和实践日志收集干预成本数据，以进行干预的成本效益评估。多方面的定性过程评估将记录实施的干预措施，并提供与实施和持续使用糖尿病患者护理登记册相关的因素的详细了解，以供传播。好处：这项研究的结果将使人们更好地理解如何利用现有的实践资源和关注的问题来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.