With increasing attention being paid to management of complex chronic conditions such as diabetes, and to population management as a care improvement strategy, the role of the Diabetes Cube is more important than ever. Since its introduction in 2006, however, uptake of the Diabetes Cube has been slow.
The purpose of this study was to determine how the daily work practices and concerns of primary care clinicians present opportunities for incorporating Diabetes Cube data. The specific research questions included:
1.What information is currently being used in identifying, treating, and managing diabetic patients, and how is it incorporated into regular clinic practice?
2.How do clinicians currently perceive and use aggregated data to address issues of population health?
The research design for this study was qualitative, cross-sectional, and descriptive in nature. The study was conducted in three VA medical centers. Phase I consisted of clinician observations in the primary care clinics at the three sites. Phase II consisted of structured interviews with primary care clinicians from the sites. Fifty-six participants representing a diversity of roles, including LPNs, RNs, nurse practitioners, clinical pharmacists, physician assistants, residents, and attending physicians, were included in the study.
Regarding the first research question, the major source of information for treating and managing diabetic patients is VA's Computerized Patient Record System (CPRS). Use of CPRS by primary care clinicians is a routine part of the patient's visit, and is also used in preparation for visits. While CPRS offers a wealth of information, it could be better organized by disease entity. Regarding the second research question, there was considerable variation across clinicians and sites in terms of familiarity with the concepts of a disease registry and population health. Clinicians were most positive to the registry idea when they perceived that registry information could be used for contributing to individual patient treatment decisions. Use of aggregated data to provide performance feedback based on patient outcomes was generally viewed positively, but it was also seen as relatively inconsequential to daily work practice. The Diabetes Cube was not necessarily associated with population health approaches, but more often envisioned as an additional tool in individual patient management, and frequently anticipated as making up for the perceived shortcomings of current forms of information provided in CPRS.
Barriers to Cube use include: limited knowledge of the concept of population health; perceived limited applicability of the population health concept to the daily practice of the average clinician; competing priorities and limited time; lack of autonomy of non-physician clinicians; patient complexity necessitating individualized care; and problems with data accuracy and timeliness. Facilitators to Cube use include: potential incorporation into CPRS, to supplement and improve the organization of existing data; and high receptivity by case managers and clinical pharmacists. These findings were used to generate recommendations for facilitating adoption of the Diabetes Cube and the concept of population health into the daily practice of VA primary care providers, which could promote improved management of patients with diabetes.
- Veinot TC, Senteio CR, Hanauer D, Lowery JC. Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis. Journal of the American Medical Informatics Association : JAMIA. 2018 Jun 1; 25(6):746-758.