Using Learning Teams for Reflective Adaptation for Diabetes

利用学习团队进行糖尿病的反思性适应

基本信息

批准号：
7494500
负责人：
David R. West
金额：
$ 57.58万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-09-15 至 2010-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7494500
关键词：
Academic Detailing Acute Address Adopted Adoption Belief Blood Glucose Blood Pressure Caring Characteristics Chronic Chronic Care Chronic Disease Classification Clinical Clinical Management Clinical Trials Colorado Communities Condition Data Depth Diabetes Mellitus Disease Effectiveness Elements End Point Environment Feedback Geographic Locations Guidelines Health system Healthcare Human Resources Individual Insurance Intervention Interview Learning Lip structure Lipids Maintenance Measurement Measures Medical Records Metabolic Methods Modeling Morbidity - disease rate Nature Non-Insulin-Dependent Diabetes Mellitus Numbers Operative Surgical Procedures Outcome Patient Care Patients Performance Phase Physicians Physiological Population Preparation Primary Care Physician Primary Health Care Procedures Process Process Assessment Randomized Randomized Controlled Clinical Trials Range Recommendation Relative (related person)Reporting Research Research Personnel Resources Self Management Services Stress Support System Surveys System Testing Translations Visit Work base chronic care model cost design evidence based guidelines experience improved innovation mortality patient oriented prevent programs prospective sound success

项目摘要

DESCRIPTION (provided by applicant): Evidence-based guidelines for primary care of diabetes have been established and disseminated, yet adoption of guidelines in community-based primary care practice has been disappointing. This effectiveness study proposes a randomized trial involving 24 community-based primary care practices to test an innovative intervention to improve diabetes care. The intervention, derived from theoretically based and efficacious programs tested in other settings, adopts a broad focus and seeks to improve diabetes care by a) increasing the practice's organizational capacity to manage change, and b) implementing and sustaining chronic care office systems that support clinician efforts to improve care for diabetes. The intervention will combine two integrated components. The first component will utilize an Improvement Facilitator that will assess the practice's current use of chronic care office systems and their organizational capacity to manage change, provide feedback to key stakeholders in the practice, and work with the practice over six months to form an Improvement Team that will both address organizational capacity to create and sustain improvement and implement chronic care systems for diabetes. In the second component of the intervention, the practice will participate in a local Improvement Collaborative that will afford opportunities to learn and share experiences during implementation and maintenance phases of the intervention with three similar practices in their geographic area. The intervention will be evaluated in two ways. First, a randomized trial using rigorous quantitative methods will measure 2 primary and 3 secondary endpoints at 12 and 24 months, including a) the ADA Physician Recognition Program performance measures by both patient-report and review of the medical record, and b) assessment of the extent to which practices implement and physicians use elements of the chronic care model in their care of diabetes. Change from baseline to 12 months will assess adoption of chronic care improvements, and change from 12 to 24 months will assess sustainability of improvements. Second, a multimethod assessment process will be used to analyze all qualitative and quantitative data separately to understand how and why the intervention led to the observed effects. The practice assessment will strive to understand which components of the interventions were most effective, their relative costs for implementation, and how they might be further improved. Successful components of the intervention will be refined and made available to our collaborators in the project; the Copic Insurance Company and the Colorado Clinical Guidelines Collaborative, for use in their statewide activities to improve diabetes care.

描述（由申请人提供）：基于证据的糖尿病初级保健指南已经建立和传播，但是在社区基于社区的初级保健实践中采用准则令人失望。这项有效性研究提出了一项随机试验，涉及24种基于社区的初级保健实践，以测试创新的干预措施以改善糖尿病护理。该干预措施源自在其他环境中测试的基于理论和有效的计划，采用了广泛的重点，并寻求通过a）提高实践的组织管理变革的组织能力来改善糖尿病护理，b）实施和维持慢性护理办公室系统，以支持临床医生为改善糖尿病的护理而努力。干预将结合两个集成的组件。第一个组件将利用改进的促进者，该协助者将评估该实践对慢性护理办公室系统的使用及其组织能力，以管理变革的能力，向主要利益相关者提供反馈，并在六个月的时间内与实践一起工作，以组建一个改进团队，以解决组织能力，以解决组织能够创建和维持糖尿病的慢性护理系统的组织能力。在干预措施的第二部分中，该实践将参加当地的改进协作，该协作将为干预措施的实施和维护阶段学习和分享经验的机会，并在其地理区域中具有三种类似的实践。干预措施将通过两种方式进行评估。首先，使用严格的定量方法的随机试验将在12和24个月时测量2个初级和3个次要终点，包括a）ADA医师识别计划的绩效指标，通过患者报告和对病历的审查，以及b）评估实践和医生在多大程度上使用糖尿病患者使用慢性护理模型的元素。从基线到12个月的变化将评估慢性护理改善的采用，从12到24个月的变化将评估改善的可持续性。其次，将使用多方法评估过程分别分析所有定性和定量数据，以了解干预措施如何以及为什么会导致观察到的效果。实践评估将努力了解干预措施的哪些组成部分，其相对实施成本以及如何进一步改善。干预的成功组成部分将得到完善并提供给我们项目中的合作者； COPIC保险公司和科罗拉多州的临床指南合作，用于其全州活动以改善糖尿病护理。