Primary care clinicians are responsible for delivering a large percentage of chronic illness care, yet adoption of new models of chronic care has been slow in these settings. Some primary care practices use disease registries to identify and track patients with chronic disease, but few collect and track clinical data to monitor and/or improve practice. To realize the benefits of an improved system of chronic care, registries must become easier to use and sustain in busy primary care offices. Information technology offers the ability to automate many of the functions of a disease registry and improve its feasibility. Also, the effectiveness of registries might be enhanced by expanding their use beyond the primary care practice to include another important member of the chronic care team: the patient. The purpose of this proposed project is to study the feasibility of implementing a patient-centered registry for improving diabetes care in primary care. Unlike typical, passive diabetes registries designed to monitor only those services initiated by clinicians, we will test a bi-directional registry where both patients and practices can enter data and receive tailored information about guideline-concordant diabetes care and self-management. A multi-step translational research framework is proposed to guide testing, implementation, and ongoing evaluation of the intervention. First, we will involve """"""""end-users"""""""" (patients, clinicians, and clinic support staff/administration) in usability testing of our patient-centered diabetes registry. Second, we will use evidence-informed processes for planning and implementing this patient-centered registry within primary care practices, with strategies designed to enhance acceptance, adoption and implementation. Finally, using a participatory research approach, we will work closely with primary care practices in ongoing learning and improvement. Using the RE-AIM framework, our evaluation is designed to study reach, effectiveness, adoption and implementation during all phases of developing and testing the patient-centered registry. Results from this project will set the stage for a full-scale randomized controlled trial to study the effectiveness of a patient-centered diabetes registry across diverse practices, clinicians and people with diabetes. ? ? ?
