Current control of hemoglobin A1c, blood pressure and lipids among patients with type 2 diabetes in primary care settings is not adequate to prevent complications. Results from an NIDDK funded R34 pilot study conducted by members of this research team suggest that Practice Facilitation is feasible and may improve these risk factors. Practice facilitation occurs when a trained facilitator meets with a team of staff and clinicians in each practice over a period of several months. Facilitation meetings create time for learning and reflection by members of the team and improve their communication so that they can adopt and implement a strategy to improve patient care. The purpose of this study is to use a Practice Facilitation intervention to improve the above three risk factors among patients with type 2 diabetes in small, autonomous primary care practices. This intervention is based on complex adaptive system theory to support the selection, tailoring and implementation of one or more strategies to improve the above 3 risk factors in each intervention practice. Five strategies will be discussed during the facilitation to stimulate change in each practice: a diabetes registry, point-of-care testing of HbAlc and lipids, group clinic visits, improved decision support during the visit, and patient activation prior to each visit. The specific objectives are : 1) To evaluate the effectiveness and sustainability of practice facilitation to improve risk factors for type 2 diabetes complications across a variety of primary care settings; 2) Assess the implementation of the chronic care model(CCM) in response to the intervention; 3) Examine the relationship between communication within the practice team and the implementation of the CCM model; and 4) From the perspective of the organization conducting the intervention and the primary care practice, examine the cost of implementing the intervention relative to risk factor change. The study will be a cluster randomized trial conducted in 40 primary care practices randomized to intervention or control. Data will be collected on all practices and 40 patients in each practice using a multi- method assessment process at baseline, 12 and 24 months. The intervention will be a series of 15 visits to 20 intervention practices by trained facilitators over 12 months. Primary hypotheses will be tested with 12 month outcome data. Sustainability of the intervention will be tested with 24 month data. Insights will be included in a delayed intervention conducted in control practices and evaluated in a pre-post design.. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
1R18DK075692-01A1
Application #
7262792
Study Section
Special Emphasis Panel (ZDK1-GRB-1 (J1))
Program Officer
Staten, Myrlene A
Project Start
2007-05-01
Project End
2012-04-30
Budget Start
2007-05-01
Budget End
2008-04-30
Support Year
1
Fiscal Year
2007
Total Cost
$509,658
Indirect Cost
Name
University of Texas Health Science Center San Antonio
Department
Family Medicine
Type
Schools of Medicine
DUNS #
800772162
City
San Antonio
State
TX
Country
United States
Zip Code
78229
Noël, Polly Hitchcock; Jones, Salene; Parchman, Michael L (2016) Patient Experience in an Era of Primary Care Transformation: Revisiting the PACIC. Eur J Pers Cent Healthc 4:528-540
Noël, Polly H; Parchman, Michael L; Palmer, Ray F et al. (2014) Alignment of patient and primary care practice member perspectives of chronic illness care: a cross-sectional analysis. BMC Fam Pract 15:57
Noël, Polly Hitchcock; Romero, Raquel Lozano; Robertson, Michaela et al. (2014) Key activities used by community based primary care practices to improve the quality of diabetes care in response to practice facilitation. Qual Prim Care 22:211-9
Culler, Steven D; Parchman, Michael L; Lozano-Romero, Raquel et al. (2013) Cost estimates for operating a primary care practice facilitation program. Ann Fam Med 11:207-11
Parchman, Michael L; Noel, Polly H; Culler, Steven D et al. (2013) A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Sci 8:93
Noël, Polly Hitchcock; Lanham, Holly J; Palmer, Ray F et al. (2013) The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams. Health Care Manage Rev 38:20-8
Bowers, Krista W; Robertson, Michaela; Parchman, Michael L (2012) How inclusive leadership can help your practice adapt to change. Fam Pract Manag 19:8-11
Mackey, Katherine; Parchman, Michael L; Leykum, Luci K et al. (2012) Impact of the Chronic Care Model on medication adherence when patients perceive cost as a barrier. Prim Care Diabetes 6:137-42
Parchman, Michael L; Wang, Chen-Pin (2012) Initiation of insulin among veterans with type 2 diabetes and sustained elevation of A1c. Prim Care Diabetes 6:19-25
Arar, Nedal H; Noel, Polly H; Leykum, Luci et al. (2011) Implementing quality improvement in small, autonomous primary care practices: implications for the patient-centred medical home. Qual Prim Care 19:289-300

Showing the most recent 10 out of 12 publications