Mobile Diabetes Education Teams in Primary Care
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 900
- 主要终点
- Change from 12 months prior to intervention in HbA1c up to 12 months during the intervention
研究概览
简要总结
The purpose of this study is to evaluate the implementation of the Mobile Diabetes Education Team (MDET) intervention in the Greater Toronto Area, as well as the intervention's effectiveness in improving patient clinical and care process outcomes.
The study's hypotheses are that the MDET intervention results in the following outcomes:
- Improvement in patient clinical outcomes;
- An increase in the proportion of primary care physicians (PCPs) performing patient care processes according to clinical practice guidelines;
- An increase in the proportion of referrals to, and patients' utilization of, diabetes education programs (DEPs).
详细描述
The proposed research is the first evaluation of the implementation of Mobile Diabetes Education Teams (MDETs) in Canada. This intervention will support primary care providers (PCPs) by offering a diabetes education team (one registered nurse [RN] and one registered dietitian [RD]) one to four times a month, based on patient volume, at various primary care sites to assist in and share the care and management of patients with diabetes. This intervention is in collaboration with the Mississauga Halton Local Health Integration Network (MH LHIN) and will be hosted by Trillium Diabetes Management Centre and Halton Diabetes Program. Each hosting site received permanent operational funding for half a diabetes education team (salary support) from the Ontario Ministry of Health and Long-term Care (MHLTC) under the new Ontario Diabetes Strategy.
The rationale for incorporating MDETs in primary care was guided by the extensive literature on the underuse and low referral to diabetes education programs (DEPs), where diabetes self-management education is primarily offered. Low utilization is due to low PCP referral rates to these services, as well as numerous systematic and operational barriers for both PCPs and patients. Consequently, the majority of Canadians are receiving diabetes care solely from their PCPs, who have expressed barriers to caring for diabetes patients and are providing sub-optimal care as they are not consistently adhering to clinical practice guidelines. As a result, MHLTC is investing millions of dollars in expanding and aligning current programs to increase access to team-based care.
The objective of this research is to evaluate a structural redesign in how the investigators deliver diabetes care and self-management education using a collaborative approach between PCPs and DEPs guided by the Chronic Care Model as a conceptual framework. The purpose of this research is twofold: 1) to evaluate the effects of MDET intervention on: (i) patient clinical outcomes; (ii) quality of care patients receive from PCPs; (iii) PCPs' referral to and their patients' utilization of DEPs; and 2) to assess the implementation processes of the MDET intervention and the degree of collaboration and team functioning between PCPs and the MDET members across primary care sites. A mixed-methods approach is proposed over a three year period.
Patients will be referred to the MDET by PCPs. The MDET will meet with patients for two hours (one hour with the RN and one hour with the RD) to assess the level of diabetes knowledge, diabetes self-care and lifestyle habits; this data will be used to develop patient treatment priorities and action care plans. Three 30 minute follow-up visits with the MDET will be carried out over a one-year period for all patients where patient action plans are reviewed, discussed and potentially revised. A communication tool has been developed to better facilitate communication of patient information between PCPs and MDETs. Case conferences will be conducted when major changes are to be made to the patient's treatment plan after a patient's visit. Accordingly, PCPs and educators are collaboratively managing patient care.
A cluster-randomized trial stepped wedge design will be used to ensure all sites will eventually receive the intervention, while still facilitating the comparison of change within individuals and between study groups across time points that is attributed to the intervention. The inclusion criteria for reviewing patient medical records are patients who are over 18 years of age, have type 2 diabetes, and have an HbA1c of greater than 8%. Twenty unique patient chart extractions will be performed at 0, 6, 12, 18, 24 months from 12 primary care sites to collect patient care processes and patient clinical outcome data (for a total of 1,200 patient charts). Characteristics of interprofessional collaboration between PCPs and the MDET will be assessed at each practice site at the end of one year. To assess the implementation of the MDET across sites, qualitative process data, such as in-depth interviews with patients, PCPs and the MDETs, and MDETs' field notes and debriefing sessions will be analyzed.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Has Diabetes Mellitus, Type 2;
- •Is 18 years of age or older;
- •Has an HbA1c of > 8%.
排除标准
- •Has type of diabetes that requires intense and specialized treatment, such as Type 1 diabetes, gestational diabetes, or patients on a multiple, daily insulin regime.
结局指标
主要结局
Change from 12 months prior to intervention in HbA1c up to 12 months during the intervention
时间窗: At 12 months prior to intervention; up to 12 months during the intervention
Change in patients' results for HbA1c from 12 months prior to intervention up to 12 months during the intervention.
次要结局
- Change from 12 months prior to intervention in low-density lipoprotein (LDL-C) up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- Change from 12 months prior to intervention in lipid profile testing up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- Change from 12 months prior to intervention in flu vaccine provision or recommendation up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- MDET educators' interview responses regarding interprofessional collaboration in, and the implementation of, the intervention(At 12 months of intervention)
- MDET educators' quarterly debriefing session group discussions regarding intervention issues(Up to 2 years)
- Change from 12 months prior to intervention in blood pressure testing up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- Change from 12 months prior to intervention in Diabetes Education Program referrals at 12 months of intervention(12 months prior to intervention to 12 months of the intervention)
- Patient attendance at scheduled MDET visits(At 12 months of intervention)
- Collaborative Practice Assessment Tool scores of PCPs and MDET educators in intervention(At 12 months of intervention)
- Change from 12 months prior to intervention in foot exams up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- Change from 12 months prior to intervention in dilated retinal exam referrals up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- PCPs' interview responses regarding interprofessional collaboration in, and the implementation of, the intervention(At 12 months of intervention)
- Change from 12 months prior to intervention in blood pressure up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- Patients' interview responses regarding intervention effectiveness(At 12 months of intervention)
- Change from 12 months prior to intervention in total cholesterol-high density lipoprotein ratio (TC-HDL ratio) up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- Change from 12 months prior to intervention in testing for HbA1c up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- Change from 12 months prior to intervention in nephropathy screening up to 12 months during the intervention(At 12 months prior to intervention; up to 12 months during the intervention)
- MDET educators' reflective journal responses regarding interprofessional collaboration in, and the implementation of, the intervention(Up to 2 years)
研究者
Enza Gucciardi
Assistant Professor
Toronto Metropolitan University