The UCSF Collaborative Research Network is a growing network of primary care clinicians and practices that care for diverse patient populations. The CRN is committed to innovation at the practice level through the use of information technology, evidence-based tools, and systematic self-management support. With the recent addition of Community Health Network of San Francisco (CHNSF) providers to the CRN, the network's focus on priority populations has increased. Safety net practices provide care for populations with a high prevalence of limited health literacy and limited English proficiency, communication barriers that contribute to disparities in chronic disease outcomes. The IDEALL Project (Improving Diabetes Efforts Across Language and Literacy) is a 3-arm randomized controlled trial of a communication technology-based intervention (automated telephone diabetes management) to an interpersonally-oriented intervention (group medical visits) in a CRN-affiliated safety-net health system, the Community Health Network of San Francisco (CHNSF). The current proposal aims to (1) expand exposure of these self-management support strategies to more patients and providers in a total of 4-5 primary care practices within the CHNSF; (2) compare the relative effects of these two interventions with respect to each other as well as to usual primary care; and (3) explore contextual factors that moderate both the effects of the interventions on patient outcomes as well as the success of implementation and maintenance. The outcomes of interest for the IDEALL Project will include extent of patient participation, engagement with the interventions, changes in diabetes indices (such as diabetes self-efficacy, glycemic control), and relative resource use. Candidate moderating variables of interest will include those at the patient/family level, clinician level, practice level, and organization level; additional contextual factors will reside in the interfaces between levels, such as the patient-clinician interface, the clinician-practice interface, the patient-practice interface, and organization-practice interface. Measures of main outcomes will consist of quantitative data; contextual factors will be collected through a combination of quantitative and qualitative methods, and analyses will proceed via a mixed methods approach. We plan to apply what we learn with regard to effectiveness and contextual factors to help us assess the transferability of interventions to other CRN practices so as to target and facilitate future implementation and maintenance efforts. This proposal presents an opportunity both to assess the degree to which results of efficacy studies can be translated into improvements in health status for priority populations within a safety-net delivery system, as well as to identify those characteristics of the complex patient-clinician-practice-organization ecology that influence effectiveness for the target population. ? ? ?
