Using Practice Facilitation and Operationalizing Referral Information Technology (UP FOR IT) to Increase DSMES Utilization

使用实践促进和操作推荐信息技术 (UP FOR IT) 来提高 DSMES 利用率

• 批准号: 10604394
• 负责人: Mary E. Lacy
• 金额: $ 30.49万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10604394
• 关键词: Address; Adult; American; Appalachian Region; Awareness; Blood Glucose; Caring; Charge; Clinic; Clinical; Communities; Complications of Diabetes Mellitus; County; Data; Diabetes Mellitus; Diagnosis; Disease; Education; Educational process of instructing; Electronics; Eligibility Determination; Evaluation; Face; Feasibility Studies; Geography; Glycosylated hemoglobin A; Goals; Guidelines; Health; Health Care Costs; Health system; Healthcare Systems; Individual; Information Technology; Intervention; Interview; Kentucky; Maps; Morbidity - disease rate; Motivation; Outcome; Participant; Patients; Persons; Pilot Projects; Population; Practical Robust Implementation and Sustainability Model; Prevalence; Process; Provider; Public Health; Public Health Administration; Quality of life; Randomized; Recommendation; Research Design; Rural; Secure; Services; Surveys; System; Testing; care costs; combat; community clinic; cost; cost effective; diabetes self-management; dissemination trial; effectiveness testing; empowerment; evidence base; glycemic control; health disparity populations; health information technology; implementation evaluation; implementation framework; implementation process; implementation science; implementation trial; implementation/effectiveness; improved; innovation; insight; mortality; primary care clinic; primary care clinician; program costs; programs; response; rural area; skills; system-level barriers; telehealth; uptake

PROJECT SUMMARY The prevalence of diabetes in Kentucky is ~25% higher than the national average, and rural areas within Kentucky face an even higher burden of diabetes and its related complications. Diabetes self-management education and support (DSMES) services are integral to quality diabetes care. Substantial evidence shows that DSMES participation improves diabetes outcomes and is cost-effective. Despite strong evidence of benefit and clear guidelines from the American Diabetes Association recommending its use, <10% of eligible individuals complete DSMES. Determinants that contribute to low DSMES uptake exist at multiple levels and include clinician awareness, geographic availability, cost and reimbursement, and referral mechanisms. Although the Kentucky Department of Public Health administers a statewide DSMES program that is free to participants and available face-to-face in 80/120 counties and by telehealth in all counties, DSMES utilization remains low across Kentucky. In response to the current RFA seeking to test innovative and pragmatic approaches to facilitate greater use of DSMES, we propose testing and evaluating a clinic-level intervention that implements health information technology (automated patient identification and a bidirectional referral system) to reduce barriers related to identification and referral of eligible patients and engages clinical teams in a practice facilitation collaborative to increase clinician awareness and overcome clinic-level barriers. We will achieve this through three aims: 1) Planning – implementation science-guided evaluation and adaptation of an existing pilot diabetes clinical quality improvement program; 2) Implementation – of the adapted intervention; and 3) Evaluation - of intervention components using the Practical, Robust Implementation and Sustainability Model (PRISM). We will adapt the proposed intervention from a successful pilot project that used health information technology and a collaborative quality improvement approach to increase DSMES utilization at participating clinics by >100%. We will use a pragmatic cluster randomized study design to evaluate implementation effectiveness and will use an implementation science framework to guide evaluation of the feasibility, acceptability, and sustainability of the intervention. To achieve the study aims, we have partnered with the Kentucky Department of Public Health (DSMES provider), the Kentucky Regional Extension Cooperative (practice facilitation partner), Kentucky Health Information Exchange (health information technology partner) and two healthcare systems in rural Kentucky. This pilot and feasibility study will provide insight on pragmatic, scalable, and sustainable strategies to increase DSMES utilization. Findings will generate key preliminary data that will guide planning of an R01-level dissemination and implementation trial with the goal of reducing diabetes-related morbidity and mortality.

项目摘要 肯塔基州糖尿病的患病率比全国平均平均水平高约25％，在 肯塔基州面临糖尿病及其相关并发症的更高燃烧。糖尿病自我管理 教育和支持（DSMES）服务是质量糖尿病护理不可或缺的一部分。大量证据表明 DSMES的参与改善了糖尿病结局，并且具有成本效益。尽管有强烈的福利证据和 美国糖尿病协会的明确指南建议使用<10％的合格个人 完成DSMES。有助于低DSME摄取的决定因素有多个层次，包括 临床医生意识，地理可用性，成本和报销以及转诊机制。虽然 肯塔基州公共卫生部管理全州DSMES计划，该计划对参与者和 在80/120县和所有县的远程医疗中，DSME的使用仍然很低 整个肯塔基州。为了回应目前寻求测试创新和务实方法的RFA 促进更多使用DSME，我们建议对实施的诊所水平干预进行测试和评估 健康信息技术（自动化患者识别和双向推荐系统）以减少 与合格患者的识别和转诊相关的障碍，并参与临床团队的实践 促进合作，以提高临床意识并克服临床水平的障碍。我们将实现这一目标 通过三个目的：1）计划 - 实施科学指导的评估和现有飞行员的适应 糖尿病临床质量改善计划； 2）实施 - 适应的干预措施； 3） 评估 - 使用实用，强大的实施和可持续性模型的干预组件 （棱镜）。我们将调整成功使用健康信息的成功试点项目的拟议干预措施 技术和协作质量改进方法，以增加参与时DSME的利用率 诊所> 100％。我们将使用务实的群集随机研究设计来评估实施 有效性，并将使用实施科学框架来指导可行性评估， 可接受性和干预的可持续性。为了实现研究的目的，我们与 肯塔基州公共卫生部（DSMES提供商），肯塔基州地区推广合作社 （实践设施合作伙伴），肯塔基州健康信息交流（健康信息技术合作伙伴） 和肯塔基州的两个医疗保健系统。这项飞行员和可行性研究将提供有关务实的见解， 可扩展和可持续的策略，以增加DSMES利用率。调查结果将生成关键的初步数据 这将指导R01级传播和实施试验的计划，以减少 与糖尿病有关的发病率和死亡率。