Feasibility and impact of implementing a private care system’s diabetes quality improvement intervention in the safety net: a cluster-randomized trial

Implementation Science

Jennifer DeVoe⁴  Wiley Chan⁵  James Dudl⁷  Amit Shah³  Emma Abiles²  Colleen Howard²  Victoria Jaworski³  MaryBeth Mercer¹  Ann Turner¹  Greg Nichols⁶  Nancy Perrin⁶  Jon Puro²  Meena Mital³  Christian Hill¹  John Muench⁴  James Davis⁶  Celine Hollombe⁶  Arwen Bunce⁶  Stuart Cowburn²  Christine Nelson²  Rachel Gold² 

[1] Virginia Garcia Memorial Health Center, 2935 SW Cedar Hills Blvd., Beaverton 97005, OR, USA;OCHIN, Inc., 1881 SW Naito Parkway, Portland 97201, OR, USA;Multnomah County Public Health Department, 426 SW Stark St, 8th Floor, Portland 97204, OR, USA;Oregon Health Science University, 3181 S.W. Sam Jackson Park Rd., Portland 97239, OR, USA;Kaiser Permanente Northwest Medical Group, 500 NE Multnomah Street, Suite 100, Portland 97232, OR, USA;Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland 97211, OR, USA;Kaiser Permanente Community Benefit, 6880 Paseo Laredo, La Jolla 92037, CA, USA

关键词: Translational medical research;    Diabetes mellitus;    Quality improvement;    Community health centers;   

Others  :  1219021
DOI  :  10.1186/s13012-015-0259-4

 received in 2014-12-04, accepted in 2015-05-08,  发布年份 2015

【 摘 要 】

Background

Integrated health care delivery systems devote considerable resources to developing quality improvement (QI) interventions. Clinics serving vulnerable populations rarely have the resources for such development but might benefit greatly from implementing approaches shown to be effective in other settings. Little trial-based research has assessed the feasibility and impact of such cross-setting translation and implementation in community health centers (CHCs). We hypothesized that it would be feasible to implement successful QI interventions from integrated care settings in CHCs and would positively impact the CHCs.

Methods

We adapted Kaiser Permanente’s successful intervention, which targets guideline-based cardioprotective prescribing for patients with diabetes mellitus (DM), through an iterative, stakeholder-driven process. We then conducted a cluster-randomized pragmatic trial in 11 CHCs in a staggered process with six “early” CHCs implementing the intervention one year before five “‘late” CHCs. We measured monthly rates of patients with DM currently prescribed angiotensin converting enzyme (ACE)-inhibitors/statins, if clinically indicated. Through segmented regression analysis, we evaluated the intervention’s effects in June 2011–May 2013. Participants included ~6500 adult CHC patients with DM who were indicated for statins/ACE-inhibitors per national guidelines.

Results

Implementation of the intervention in the CHCs was feasible, with setting-specific adaptations. One year post-implementation, in the early clinics, there were estimated relative increases in guideline-concordant prescribing of 37.6 % (95 % confidence interval (CI); 29.0–46.2 %) among patients indicated for both ACE-inhibitors and statins and 38.7 % (95 % CI; 23.2–54.2 %) among patients indicated for statins. No such increases were seen in the late (control) clinics in that period.

Conclusions

To our knowledge, this was the first clinical trial testing the translation and implementation of a successful QI initiative from a private, integrated care setting into CHCs. This proved feasible and had significant impact but required considerable adaptation and implementation support. These results suggest the feasibility of adapting diverse strategies developed in integrated care settings for implementation in under-resourced clinics, with important implications for efficiently improving care quality in such settings.

ClinicalTrials.gov

NCT02299791 webcite.

【 授权许可】

   
2015 Gold et al.

【 图 表 】

Fig. 1.

Fig. 2.

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