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（由申请人提供）：美国的糖尿病护理始终未能达到建议的质量标准。障碍阻碍了将循证指南转化为可持续实践。很少有研究考虑多重障碍，并且在选择干预措施来克服障碍时缺乏循证策略。该提案涉及对初级保健网络中遵守糖尿病指南的实践障碍进行全面评估。基于 Cabana 等人提出的框架的障碍评估工具 (BAT)。 (1999) 将被验证与提供者和实践对糖尿病护理指南的遵守情况相关。我们的网络中实施的糖尿病流程表将被评估并与测量的障碍相关联，以跟踪对指南的遵守情况。该组织战略将支持采用基于证据的质量主动干预方法。 BAT 将适用于我们的 25 个初级保健诊所网络中的执业团队成员：提供者、支持人员和执业经理。测试了五个假设： 答：最佳可行技术衡量了遵守糖尿病指南的障碍，同时显示出足够的内部一致性和可识别的子量表结构。 B：BAT 结果与实践和提供商对 ADA 指南的遵守程度成反比。 C：BAT 分数与糖尿病流程表的使用呈负相关。 D：BAT 评分与临床结果（血糖和血脂控制）呈负相关。 E：糖尿病流程表的使用与提供者和实践对 ADA 指南的更高遵守程度相关。 然后，最佳可行技术将提供全面评估障碍的结构。研究的 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 是一个现实世界实验室，致力于将证据转化为各种实践的研究。该网络于 2002 年成为 AHRQ 资助的 PBRN，刚刚完成了对慢性病患者护理的随机干预。 Crozer-Keystone 健康网络质量委员会基础设施历来支持指南的遵守和循证医学在实践中的传播。该网络处于实施和研究这一拟议组织战略的最佳位置。