There is clear evidence that the transfer of research findings into practice is slow and inconsistent. While improving physician knowledge is necessary, it is not sufficient to change practice. Abundant literature points to the inability of traditional continuing medical education (CME), such a lectures and conferences, to produce sustained change in practice. It has been shown that multifaceted organizational interventions, particularly those that provide systems support and reinforcing strategies, are the most effective in promoting sustained physician behavior change. The Institute of Medicine (IOM) in its 2001 Quality Chasm report, underscored that improvement requires redesign of the small units of care, or """"""""Microsystems,"""""""" i.e. the practice teams comprised of the physician, nurse, and other support staff. The IOM also concluded that for the microsystems to thrive, systems support of health care organizations is needed. The ACP-ASIM proposes to develop a two-phase project to plan and test a team-oriented, multifaceted, practice-based CME intervention strategy that targets improvement of quality of care. Patients with type 2 diabetes will serve as the prototype medical condition for this study. We will base the intervention on the social learning network model for quality improvement and the chronic care model for systems change. This innovative CME intervention intends to effect change by creating and facilitating what we will refer to as Level 1 and Level 2 partnerships. Level 1 partnerships refer to the collaborations between the national medical and nursing societies, health plans, volunteer health organizations, and other key stakeholders. Level 2 refers to the microsystem itself, the partnership between physicians, nurses, and administrators who provide the direct patient care. The Level 1 partnerships will nurture and support the Level 2 partnerships. The Level 2 partnerships will receive training in a team-based intervention, will implement the intervention, and will provide feedback and practice data. Our hypothesis is that through Level 1 and 2 partnerships, the development and implementation of a team-oriented practice-based intervention will lead to improved quality of care and patient outcomes. Phase one (grant year 1) will be used for building Level 1 partnerships and planning the Level 2 intervention. Phase two (grant years 2 and 3) will be used to conduct a randomized controlled trial to test the effectiveness of this new CME strategy.
