Using Practice Facilitation and Operationalizing Referral Information Technology to Increase DSMES Utilization

Study Overview
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Brief Summary
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This is a pilot and feasibility study of a pragmatic cluster randomized trial that utilizes health information technology and practice facilitation to address referral barriers and increase clinician awareness and motivation to refer patients with diabetes to diabetes self-management education and services (DSMES).

Detailed Description
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Diabetes self-management education and support (DSMES) is an evidence-based educational program that helps people with diabetes better control their blood sugar (improved hemoglobin A1c) and reduce diabetes-related complications and healthcare costs. DSMES is strikingly underutilized with fewer than 10% of eligible patients receiving this helpful service due to patient-, clinician-, and health system-level barriers that include low clinician awareness and lack of integrated referral processes between clinics and community-based DSMES programs. In this study, we will conduct a pilot and feasibility study of a pragmatic cluster randomized trial that utilizes health information technology and practice facilitation to address referral barriers and increase clinician awareness and motivation to refer patients with diabetes to DSMES. We have partnered with the Kentucky Department of Public Health (KDPH, statewide DSMES provider), the Kentucky Regional Extension Center (KY-REC, practice facilitation partner), and the Kentucky Health Information Exchange (health information technology (HIT) partner). We will recruit two healthcare systems in rural Kentucky to participate in the study. Within each healthcare organization, we will randomize control and intervention clusters at the clinic level. Clinics in the intervention group will participate in the 12-month intervention which incorporates health information technology and practice facilitation. The health information technology component provides the scaffolding for quality improvement efforts by automating patient identification and enabling bi-directional referral communication between providers and DSMES programs. Health information technology support will be available at all clinic sites within participating health care organizations, including the control clinics. The practice facilitation collaborative trains and supports clinical teams to use the Model for Improvement to make breakthrough improvements in diabetes care and DSMES utilization by recognizing barriers and changing clinical systems and care practices.

Official Title
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Clinical Trial Protocol: Using Practice Facilitation and Operationalizing Referral Information Technology (UP FOR IT) to Increase DSMES Utilization

Conditions
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Diabetes

Intervention / Treatment
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* Other: UP FOR IT - practice facilitation
* Other: UP FOR IT - health information technology


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Clinics are being recruited to participate in the intervention. All clinic staff at participating clinics are eligible for inclusion in the study. Exclusion Criteria: - There are no exclusion criteria beyond employment at a participating clinic.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control Cluster<br>Clinics in the control group will only be provided with health information technology; they will not participate in the 12-month intervention which incorporates health information technology and practice facilitation. | Other: UP FOR IT - health information technology<br>* Using Practice Facilitation and Operationalizing Referral Information Technology (UP FOR IT) involves incorporation of health information technology and practice facilitation. The health information technology component provides the scaffolding for quality improvement efforts by automating patient identification and enabling bi-directional referral communication between providers and diabetes self-management education and services (DSMES) programs.<br>|
| Experimental: Intervention Cluster<br>Clinics in the intervention group will participate in the 12-month intervention which incorporates health information technology and practice facilitation. | Other: UP FOR IT - practice facilitation<br>* Using Practice Facilitation and Operationalizing Referral Information Technology (UP FOR IT) involves incorporation of health information technology and practice facilitation. The practice facilitation collaborative trains and supports clinical teams to use the Model for Improvement to make breakthrough improvements in diabetes care and DSMES utilization by recognizing barriers and changing clinical systems and care practices.<br>Other: UP FOR IT - health information technology<br>* Using Practice Facilitation and Operationalizing Referral Information Technology (UP FOR IT) involves incorporation of health information technology and practice facilitation. The health information technology component provides the scaffolding for quality improvement efforts by automating patient identification and enabling bi-directional referral communication between providers and diabetes self-management education and services (DSMES) programs.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in DSMES Referrals | DSMES referrals will be measured as change in clinic-level referral rate from baseline to the end of the active intervention and follow-up period. The outcome will be assessed through clinic electronic health record data. | 18 months (baseline and post-study) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in DSMES Attendance | DSMES attendance will be measured as the change in clinic-level attendance rate from baseline to the end of the active intervention and follow-up period. The outcome will be assessed through aggregated, de-identified data that is routinely collected by DSMES providers. | 18 months (baseline and post-study) | 
| Change in A1c Levels | Participant A1c levels will be measured from baseline to the end of the active intervention and follow-up period. The outcome will be assessed through clinic-level aggregate data extracted from electronic health record data. | 18 months (baseline and post-study) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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diabetes self-management education and support (DSMES), implementation science, practice facilitation, health information technology, evidence-based practice, rural clinics