We propose a demonstration and dissemination project that extends a cardiovascular disease risk-reduction program shown to be effective among patients with Diabetes Mellitus (DM) in an integrated HMO population, to a vulnerable outpatient population receiving DM care in 11 Federally Qualified Health Center (FQHC) clinics in the Portland, OR metropolitan area. Adults with DM and other risk factors who take aspirin, statins, and ACE Inhibitors can reduce their risk of cardiovascular events by as much as 40%;the proposed study will adapt intervention strategies used by Kaiser Permanente to increase the percentage of DM patients on these medications in the study clinics. Intervention strategies derive from the Chronic Care Model and include primary-care-team-based care, active case management, clinical prompts built into the electronic medical record (EMR) common to the community clinics, linked pharmacy datasets with the EMR to monitor patient adherence, and a panel reporting tool that prioritizes clinical follow-up to those most at risk. We will determine the effectiveness of the dissemination of the intervention, and its impact on patient adherence, by measuring changes in DM population prescription rates for the target medications and changes in prescription refill rates, using a pre- post comparison within clinics and a staggered, randomized implementation across clinics. We will also conduct a process evaluation to identify the factors important to dissemination and implementation success. Our overarching goals are to identify and resolve issues in disseminating a successful program from a large, well-organized health system into community clinics, so that the program may be implemented more widely in other community health centers and practice settings with modest EMR infrastructure resources. The proposed study will pave the way for future research on disseminating evidence-based care using safety net clinics'EMR.

Public Health Relevance

Adults with diabetes who take aspirin, statins, and ACE Inhibitors can dramatically reduce their risk of cardiovascular events. Therefore, five years ago Kaiser Permanente (KP) launched an initiative to put as many of its members with diabetes as possible on this drug regimen, using the electronic medical record to identify patients not taking the medications, and to remind clinicians to start these patients on the medications;in addition, primary care case management teams contacted eligible patients. We propose to implement a similar program in eleven of Oregon's community health centers, to assess whether KP's program can be successfully disseminated in those settings, and whether it can impact the percentage of eligible patients who are prescribed and refill the target medications.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HL095481-04
Application #
8502525
Study Section
Special Emphasis Panel (ZHL1-CSR-Z (M1))
Program Officer
Wells, Barbara L
Project Start
2010-09-07
Project End
2015-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
4
Fiscal Year
2013
Total Cost
$615,100
Indirect Cost
$104,943
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
150829349
City
Oakland
State
CA
Country
United States
Zip Code
94612
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Gold, Rachel; Bunce, Arwen; Cowburn, Stuart et al. (2017) Cardiovascular care guideline implementation in community health centers in Oregon: a mixed-methods analysis of real-world barriers and challenges. BMC Health Serv Res 17:253
Gold, Rachel; Bunce, Arwen E; Cohen, Deborah J et al. (2016) Reporting on the Strategies Needed to Implement Proven Interventions: An Example From a ""Real-World"" Cross-Setting Implementation Study. Mayo Clin Proc 91:1074-83
Gold, Rachel; Hollombe, Celine; Bunce, Arwen et al. (2015) Study protocol for ""Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)"": a pragmatic trial comparing implementation strategies. Implement Sci 10:144
Gold, Rachel; Nelson, Christine; Cowburn, Stuart et al. (2015) Feasibility and impact of implementing a private care system's diabetes quality improvement intervention in the safety net: a cluster-randomized trial. Implement Sci 10:83
Bunce, Arwen E; Gold, Rachel; Davis, James V et al. (2014) Ethnographic process evaluation in primary care: explaining the complexity of implementation. BMC Health Serv Res 14:607
Heintzman, John; Gold, Rachel; Krist, Alexander et al. (2014) Practice-based research networks (PBRNs) are promising laboratories for conducting dissemination and implementation research. J Am Board Fam Med 27:759-62
Gold, Rachel; Muench, John; Hill, Christian et al. (2012) Collaborative development of a randomized study to adapt a diabetes quality improvement initiative for federally qualified health centers. J Health Care Poor Underserved 23:236-46