A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol
| Autor: | Raymond F. Palmer, Steven D. Culler, Michael L. Parchman, Raquel L. Romero, Jacqueline A. Pugh, Nedal H. Arar, Polly H. Noël |
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| Rok vydání: | 2008 |
| Předmět: |
Health Informatics
Health informatics law.invention Health administration Study Protocol 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Nursing law Intervention (counseling) Medicine 030212 general & internal medicine Complex adaptive system Health policy Medicine(all) Chronic care lcsh:R5-920 business.industry 030503 health policy & services Health Policy Public Health Environmental and Occupational Health Health services research General Medicine 3. Good health lcsh:Medicine (General) 0305 other medical science business |
| Zdroj: | Implementation science : IS Implementation Science, Vol 3, Iss 1, p 15 (2008) |
| ISSN: | 1748-5908 |
| DOI: | 10.1186/1748-5908-3-15 |
| Popis: | Background Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids – three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is practice facilitation (PF). PF creates time for learning and reflection by members of the team in each clinic, improves their communication, and promotes an individualized approach to implement a strategy to improve patient outcomes. Specific objectives The specific objectives of this protocol are to: evaluate the effectiveness and sustainability of PF to improve risk factor control in patients with type 2 diabetes across a variety of primary care settings; assess the implementation of the CCM in response to the intervention; examine the relationship between communication within the practice team and the implementation of the CCM; and determine the cost of the intervention both from the perspective of the organization conducting the PF intervention and from the perspective of the primary care practice. Intervention The study will be a group randomized trial conducted in 40 primary care clinics. Data will be collected on all clinics, with 60 patients in each clinic, using a multi-method assessment process at baseline, 12, and 24 months. The intervention, PF, will consist of a series of practice improvement team meetings led by trained facilitators over 12 months. Primary hypotheses will be tested with 12-month outcome data. Sustainability of the intervention will be tested using 24 month data. Insights gained will be included in a delayed intervention conducted in control practices and evaluated in a pre-post design. Primary and secondary outcomes To test hypotheses, the unit of randomization will be the clinic. The unit of analysis will be the repeated measure of each risk factor for each patient, nested within the clinic. The repeated measure of glycosylated hemoglobin A1c will be the primary outcome, with BP and Low Density Lipoprotein (LDL) cholesterol as secondary outcomes. To study change in risk factor level, a hierarchical or random effect model will be used to account for the nesting of repeated measurement of risk factor within patients and patients within clinics. This protocol follows the CONSORT guidelines and is registered per ICMJE guidelines: Clinical Trial Registration Number NCT00482768 |
| Databáze: | OpenAIRE |
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