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

Not Applicable

Completed

• Conditions: Diabetes

• Registration Number: NCT05472142
• Lead Sponsor: Mary Lacy

Brief Summary

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

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.

Study Timeline

• Study First Submitted: 2022-07-21
• Study First Submitted QC: 2022-07-21
• Study First Posted: 2022-07-25
• Study Start: 2023-05-30
• Primary Completion: 2024-10-30
• Study Completion: 2024-10-30
• Status Verified: 2025-08
• Last Update Submitted: 2025-08-11
• Last Update Posted: 2025-08-15

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 22

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.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Change in DSMES Referrals	Baseline, End of active intervention (month 9), End of follow-up (month 15)	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.

Secondary Outcome Measures

Name	Time	Method
Change in DSMES Attendance	Baseline, End of active intervention (month 9), End of follow-up (month 15)	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.
Change in % of patients with A1c >9%	Baseline, End of active intervention (month 9), End of follow-up (month 15)	Change in % of patients with A1c \>9% 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.

Trial Locations

Locations (1)

University of Kentukcy; 🇺🇸 Lexington, Kentucky, United States