Problem: Diabetes is the fifth leading cause of death in the US and is predicted to increase in incidence by 42% from 1995 to 2025. Diabetes also contributes to increased rates of morbidity with overall estimated costs of $132 billion annually. Although most adults with diabetes seek their care from primary care physicians, adherence to diabetes treatment guidelines in these settings remains less than optimal. Quality improvement interventions based on the IMPACT model of primary care practice change have led to improved practice performance. However, the resources needed to accomplish these changes limit the possibility of translating these findings into the financially stressed primary care environment. We will address the question: How can primary care practices use their existing capacities cost-effectively to improve adherence to diabetes guidelines? Purpose: To test the feasibility of an organizational change intervention designed to improve adherence to evidence-based diabetes treatment guidelines in primary care by improving practice-level self understanding. Methods: We have adapted instruments developed in a series of funded studies for use in practice self-assessment. Six primary care practices will use these tools to assess existing diabetes care processes. Practices will use the organizational self-assessment findings to direct the development of a disease registry and integrate the use of the registry into existing workflow to improve processes of care that are tightly linked to intermediate outcomes. A field researcher will collect qualitative and quantitative data on the feasibility of the intervention, expenses associated with the process of registry development and use, and on the fidelity of the self-assessment process. We will assess diabetes care quality before and after the intervention through medical record review. Outcomes: Analysis of the feasibility study data will inform the development of a group randomized controlled trial of the intervention. Benefit: Findings from this study will be used to develop cost-effective methods for improving diabetes care in primary care practices. Diabetes is the fifth leading cause of death in the US and the costs of diabetes care are estimated at $132 billion annually. Although most adults with diabetes seek their care from primary care physicians, adherence to diabetes treatment guidelines in these settings remains less than optimal. We propose to test, in six primary care practices, the feasibility of a low cost organizational change intervention designed to improve adherence to evidence-based diabetes treatment guidelines by improving practice level self understanding.
