Persistently poorly controlled type 2 diabetes in veterans receiving care in the United States Veterans Health Administration system Nutritional, Metabolic, Endocrine Type 2 diabetes mellitus
Conditions
Interventions
Participating facilities that have a Home Telehealth Program and are, or will be offering, ACDC - a telehealth-based program for patients with persistently poorly controlled type 2 diabetes - are assi
2) plan to link quality goals and EBP components to the workflow
3) facilitate rapid cycle quality improvement and 4) plan for sustainment and further spread. The DDN QUERI Program will evaluate the DDN with selected VA facilities in comparison to providing informa
Sponsors
United States Department of Veterans Affairs
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Healthcare facilities with a Home Telehealth Program in the Veterans Health Administration serving Veterans with persistently poorly controlled type 2 diabetes, as indicated by having an HbA1c >/=8.5% despite receipt of clinic-based services or standard telehealth approaches will be randomly assigned as part of this quality improvement evaluation. The work of these facilities will be led by teams of individuals who are: 1. VHA-employed telehealth nurse working in collaboration with a medication manager (e.g. clinical pharmacist, nurse practitioner) 2. Willing and able to deliver the ACDC self-management support modules according to a schedule to Veterans with type 2 diabetes (nurse) 3. Willing and able to receive and review phone encounters for any recommended changes to patient medications (medication manager) 4. Willing and able to be randomly assigned to one of two implementation support conditions (technical assistance or network-based structured implementation facilitation) 5. Willing and able to obtain clinic-level leadership and facility-level leadership support and approval to participate 6. Invited by DDN QUERI staff to participate in the QI program
Exclusion criteria
Exclusion criteria: Must meet all inclusion criteria noted, including being invited to participate in the QI program by DDN QUERI staff
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Appropriate dose/adherence to the ACDC clinical intervention as determined by nurse-led tracking indicating that a patient completed 80% or more of the intended phone calls and associated modules at the end of the study. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Successful delivery of core and adaptable components of ACDC measured using self-reported information on quarterly and phase reports, qualitative interviews conducted with team members before and after the beginning of implementation, and examples/descriptions of group materials and processes provided by participating facilities over approximately 1.5 years of implementation (e.g. preparation and implementation phases). 2. Intervention clinical effectiveness measured using HbA1c change from baseline to 6 months (HbA1c values pulled from EHR). 3. Process evaluation utilizing survey (Organizational Readiness for Change) and qualitative data from semi-structured qualitative interviews conducted at the start and completion of the 1-year implementation phases to capture components of the Consolidated Framework for Implementation Research (CFIR). 4. Cost of the implementation strategy and intervention will be measured based on self-reported participant activities captured using reports of both implementation and intervention activities conducted by specific individuals over the course of the Dynamic Diffusion Network or technical assistance. The cost of the implementation strategy and intervention will be measured based on self-reported participant activities captured using reports of both implementation and intervention activities conducted by specific individuals over the course of the Dynamic Diffusion Network or technical assistance. | — |
Countries
United States of America
Outcome results
None listed