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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3046 — Assessing Primary Care Readiness for Disease Registries: A Study of the Diabetes Cube

Keith RE (Ann Arbor VA HSR&D Center for Clinical Management Research), Souden M (Ann Arbor VA HSR&D Center for Clinical Management Research), Lowery JC (Ann Arbor VA HSR&D Center for Clinical Management Research)

The prevalence of complex co-morbid conditions among Veterans makes population-based management approaches particularly salient for VHA. A population-based registry is key to identifying high-risk patients to better align effective services, a core element of the Patient Aligned Care Team (PACT) initiative. The Diabetes Cube is a population-based registry introduced in 2006 to facilitate population management care practices. The objective of this study was to assess contextual and individual factors associated with organizational readiness to implement the Diabetes Cube into clinic practice, in an effort to understand challenges to implementing registries within the PACT initiative.

A cross-sectional exploratory study was performed at three VA medical centers. First, observations were carried out with 31 primary care clinicians. Second, guided by population management concepts, semi-structured interviews were conducted with 51 primary care clinicians. Inductive methods were used to identify concepts relevant to population management.

Across medical centers, clinicians had limited knowledge of population management practices; the Diabetes Cube was perceived as a comprehensive source of information that could make up for perceived shortcomings of CPRS in organizing patient data for particular disease. Many physicians thought the Diabetes Cube should be used by other clinicians, such as case managers and clinical pharmacists. Physicians did not perceive the Diabetes Cube as a population management tool affecting their own practice; instead they perceived their information needs consisting of data unique to individual patients. Variable across organizations was the presence of a case manager or clinical pharmacist who more concretely envisioned how the Diabetes Cube could be used to summarize diabetic patient information. Many non-physician providers thought the Diabetes Cube could provide an opportunity for early detection and prevention of diabetes and implementing education and follow-up to targeted patients.

Different organizational contexts present diverse challenges and opportunities that must be considered for successfully implementing disease registries.

Integrating disease registries into primary care practice is an important aspect of personalizing care for Veterans – a key principle of PACT. Our findings are informing evaluations in the Ann Arbor PACT Demonstration Lab and will help guide implementation of disease registries in VHA.

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