Article Figures & Data
Tables
Milestone Action Description 1 Identify practice champions The practice identifies two implementation champions (one lead, one alternate) 2 Set practice-level goals Stakeholders identify goals, set achievement targets, and share goals with everyone in practice 3 Define content Practice identifies specific measures to track 4 Build Practice selects software and populates the registry 5 Plan for use Registry management tasks defined and practice workflows assessed to integrate registry use into care 6 Implement workflow changes Practice workflows modified to accommodate registry use and staff are trained in use 7 Begin use Use of the registry goes live 8 Sustainable use Ongoing maintenance and monitoring of the registry to ensure continued usefulness ↵* Each intervention practice established their own timeline for achieving these milestones.
Support Activity Received by Control Practice Received by Intervention Practice Identification of practice champions X* X Support identifying T2DM patient population X X Kick off 3-hour educational meeting/champion meeting X X Basic instruction regarding creation and use of registries X X Demonstration of potential software options for registry use X X Provision of updated ADA guidelines for T2DM care X X Tool to facilitate practice self-assessment for registry adoption X X Document describing 8 milestones for registry adoption X X Interim champion meeting 15 months after kick off X X Connection to area clinician peer mentor (in person and via phone) X Access to area clinician informaticist for additional support X ↵* X, activity offered.
ADA, American Diabetes Association; T2DM, type 2 diabetes mellitus.
Bold indicates support activities only provided to intervention practices.
Baseline Characteristic All Practices (n = 28) Intervention Practices (n = 15) Control Practices (n = 13) P Value Patients* Baseline, N 2,798 1,501 1,297 Age in years, mean ± SD 63.5 ± 12.8 63.4 ± 12.9, N = 1,500 63.8 ± 12.7, N = 1,297 .7824 Women, % (N) 59 (1,636/2,795) 62 (933/1,499) 54 (703/1,295) .0686 Body mass index, mean ± SD 33.8 ± 7.9 33.5 ± 7.7, N = 1,446 34.1 ± 8.1, N = 1,260 .1478 Hemoglobin A1c, mean ± SD, % 7.4 ± 1.8 7.4 ± 1.9, N = 1284 7.5 ± 1.8, N = 1117 .8969 Systolic BP, mean ± SD, mm Hg 131.2 ± 17.3 131.7 ± 17.7, N = 1,486 130.7 ± 17.0, N = 1,296 .6074 Diastolic BP, mean ± SD, mm Hg 76.5 ± 10.6 77.0 ± 10.7, N = 1,486 76.0 ± 10.4, N = 1,296 .3635 Low-density lipoprotein level, mean ± SD, mg/dL0.0465 95.6 ± 36.8 97.8 ± 39.5, N = 1,175 93.0 ± 33.3, N = 1,021 .0465 High-density lipoprotein level, mean ± SD, mg/dL 49.0 ± 15.9 50.2 ± 16.7, N = 1,194 47.6 ± 14.7, N = 1,029 .0015 Practices,†‡ % (n) Rural 69 (22/32) 63 (10/16) 75 (12/16) .7043 <3 clinicians 50 (16/32) 56 (9/16) 44 (7/16) .7244 Baseline practice-level ACIC score, median (min., max.); range 0 to 11† Organization of healthcare system 7.5 (4.5, 11.0) 7.3 (4.8, 11.0) 7.5 (4.5, 11.0) .5366 Community linkages 6.5 (2.3, 11.0) 5.3 (2.3, 11.0) 7.5 (4.0, 8.8) .2542 Self-management support 7.0 (3.0, 11.0) 6.8 (3.0, 11.0) 8.7 (4.0, 11.0) .5371 Decision support 6.5 (4.3, 11.0) 6.5 (5.3, 11.0) 7.8 (4.3, 9.5) .8773 Delivery system design 6.6 (2.8, 10.4) 5.9 (3.0, 10.4) 6.6 (2.8, 9.6) .6888 Clinical information systems 6.0 (0, 11) 6.1 (0.0, 11.0) 6.0 (3.8, 10.3) .5377 Integration of chronic care model 6.0 (2.2, 10.7) 6.1 (3.0, 10.7) 6.0 (2.2, 9.8) .7815 Total ACIC score 6.4 (3.8, 10.8) 5.9 (4.0, 10.8) (3.8, 9.4) .4237 ACIC, Assessment of Chronic Illness Care; BP, blood pressure; SD, standard deviation.
↵* Patient information obtained from chart audits of electronic health records, with inclusion dates April 1, 2014 to March 31, 2015.
↵† 32 practices enrolled and 4 dropped out; 28 provided baseline characteristics; 23 provided ACIC scores.
↵‡ Practice Information Form completed by practice champions at first education meeting; ACIC surveys completed by practice champions after first education meeting.
