Assessing Barriers to ADA Guideline Adherence

评估遵守 ADA 指南的障碍

• 批准号: 7028833
• 负责人: MITCHELL A KAMINSKI
• 金额: $ 10万
• 依托单位: CROZER-CHESTER MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-05-15 至 2008-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7028833
• 关键词: behavioral /social science research tag; blood glucose; blood lipid; clinical research; data collection methodology /evaluation; diabetes mellitus; health behavior; health care personnel performance; health care quality; health care service availability; health care service utilization; health services research tag; human subject; information dissemination; method development; patient care management; patient care personnel attitude; perception; therapy compliance

DESCRIPTION (Provided by the Applicant): Diabetes care in the U.S. consistently fails to meet recommended quality standards. Barriers impede the translation of evidence-based guidelines into sustainable practice. Few studies have considered multiple barriers, and there is a lack of evidence-based strategy in choosing interventions to overcome barriers. This proposal involves a comprehensive assessment of practice barriers to diabetes guidelines adherence across a primary care network. A Barrier Assessment Tool (BAT) based upon a framework proposed by Cabana, et al. (1999) will be validated to correlate with provider and practice adherence to diabetes care guidelines. A Diabetes Flow Sheet implemented in our Network to track adherence to guidelines will be assessed and correlated with measured barriers. This organizational strategy will support an evidence-based approach to quality initiative interventions. The BAT will be administered to practice team members: providers, support staff, and practice managers in our network of 25 primary care practices. Five hypotheses are tested: A: The BAT measures perceived barriers to adherence to diabetes guidelines, while showing adequate internal consistency and an identifiable subscale structure. B: The BAT results inversely correlate with practice and provider adherence to ADA guidelines. C: BAT scores will inversely correlate with use of the Diabetes Flow Sheet. D: The BAT scores inversely correlate with clinical outcomes (glycemic and lipid control.) E: Use of the Diabetes Flow Sheet correlates with higher provider & practice adherence to ADA guidelines. The BAT would then provide the structure for comprehensive assessment of barriers. Study of the effectiveness of interventions targeted to barriers would be the next step in future projects and research. The Crozer-Keystone PBRN is a real-world laboratory for research in the translation of evidence into diverse practices. The Network became an AHRQ-funded PBRN in 2002 and has just completed a randomized intervention in the care of chronic disease patients. The Crozer-Keystone Health Network Quality Committee infrastructure has historically supported guideline adherence and diffusion of evidence-based medicine into practices. The Network is optimally positioned to implement and study this proposed organizational strategy.

描述（申请人提供）：美国糖尿病护理始终无法符合建议的质量标准。障碍阻碍将基于证据的指南转化为可持续实践。很少有研究考虑过多个障碍，并且缺乏基于证据的策略来选择克服障碍的干预措施。该提案涉及对跨初级保健网络遵守糖尿病指南的实践障碍的全面评估。基于Cabana等人提出的框架的障碍评估工具（BAT）。 （1999年）将得到证实，以与提供者相关并遵守糖尿病护理指南。在我们的网络中实施以跟踪遵守指南的糖尿病流程表将与测量的障碍评估并相关。该组织策略将支持基于证据的质量主动性干预措施。蝙蝠将用于实践团队成员：在我们的25种初级保健实践网络中提供者，支持人员和实践经理。检验了五个假设： 答：BAT衡量遵守糖尿病指南的障碍，同时表现出足够的内部一致性和可识别的子量表结构。 B：蝙蝠的结果与实践和提供者遵守ADA指南成反比。 C：BAT分数将与使用糖尿病流平面成反比。 D：蝙蝠的得分与临床结果（血糖控制和脂质控制）成反比。 E：糖尿病流纸的使用与较高的提供者和遵守ADA指南的练习相关。 然后，蝙蝠将为障碍的全面评估提供结构。研究 针对障碍的干预措施的有效性将是未来项目和研究的下一步。 Crozer-keystone PBRN是一家研究证据转化为多种实践的研究实验室。该网络于2002年成为AHRQ资助的PBRN，并且刚刚完成了对慢性病患者护理的随机干预措施。 Crozer-Keystone Health Network质量委员会基础设施历史上支持指南的依从性和循证医学扩散到实践中。该网络在实施和研究该提出的组织策略方面处于最佳状态。