Low-Intensity Intervention Supports Diabetes Registry Implementation: A Cluster-Randomized Trial in the Ambulatory Care Outcomes Research Network (ACORN)

Roy T. Sabo, Rebecca S. Etz, Martha M. Gonzalez, Nicole J. Johnson, Jonathan P. O'Neal, Sarah R. Reves, Jesse C. Crosson
2020 Journal of the American Board of Family Medicine  
Previous research demonstrated that registries are effective for improving clinical guideline adherence for the care of patients with type 2 diabetes. However, registry implementation has typically relied on intensive support (such as practice facilitators) for practice change and care improvement. To determine whether a remotely delivered, low-intensity organizational change intervention supports implementation and use of diabetes registries in primary care. Cluster-randomized controlled
more » ... ed controlled effectiveness trial of providing limited external support leveraging internal practice resources and problem-solving capacities for driving diabetes registry implementation in 32 practices in Virginia. All practices identified local implementation champions who participated in an in-person education session on the value and use of diabetes registries, while intervention practices were also paired with peer mentors and had access to a physician informaticist, who worked remotely to assist practices with implementation. Practice champions reported progress on registry implementation milestone achievement, and reported practice-level organizational capacity by using a modified version of the Assessment of Chronic Illness Care (ACIC). Intervention practices were significantly more likely to have implemented a registry (44% vs 6%, P = .04) and to have achieved more implementation milestones (5.5 vs 2.6, P < .0001) than control practices. Baseline ACIC scores indicated room for organizational improvement with regard to chronic illness care (overall median, 6.4; range, 3.8 to 10.8) and clinical information systems use (median, 6.0; range, 0 to 11) with no significant differences between intervention and control practices. Remotely provided guidance paired with limited in-person assistance can support rapid implementation of diabetes registries in typical primary care practices.
doi:10.3122/jabfm.2020.05.190455 pmid:32989067 fatcat:dhjyws3f2fh4lnrphv6zxqqbse