TThere is a need for a new paradigm in approaching performance improvement, i.e. implementation of evidence-based practice. Despite the fact that diabetes is one of the most common chronic disorders affecting veterans (3;4) and that performance measurement is entering its eighth year in VA, marked variation persists in control of glycemia, LDL cholesterol, and blood pressure, performance of facilities, and among racial/ethnic groups.(3-11) Reliance upon clinical reminders in CPRS and individual feedback alone has not been sufficient.(12) Moreover, the 2003 guidelines have new, more stringent evidence-based targets, necessitating more aggressive therapy.(13) Implementation of these evidence-based guidelines is essential to reduce morbidity and premature mortality of veterans with diabetes.
Our objective is to plan a project that contributes to the development of VA as a learning organization, one that systematically integrates learning and work.(1) Successful implementation of research into practice is a function of the interplay of three core elements--the strength of the evidence, the context or environment into which the research is to be implemented, and the organizational support and methods by which the process is facilitated.(2) Our hypothesis is that use of the intentional learning model will enhance performance in VISN 10. We will assess performance using measures based on the recently released VA/DOD Primary Care Practice Guidelines for Diabetes. Because we will involve all primary care sites in VISN 10, size and geographic differences will enhance generalizability to other networks.
Mixed methods (qualitative and quantitative) and primarily descriptive. Paired t-test to assess change in subjects and unpaired t-test to assess change between groups.
We will facilitate the systematic implementation of organizational learning processes that can improve healthcare, specifically related to Diabetes Mellitus.
None at this time.
Clinical practice guidelines, Diabetes, Implementation
Evidence-Based Medicine, Physician Executives