Challenges in Identifying Patients with Type 2 Diabetes for Quality-Improvement Interventions in Primary Care Settings and the Importance of Valid Disease Registries

Wozniak, Lisa; Soprovich, Allison; Rees, Sandra; Johnson, Steven T.; Majumdar, Sumit R.; Johnson, Jeffrey

doi:10.1016/j.jcjd.2015.05.001

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…Across settings and health care professions, T2D can remain undiagnosed for many years [23], indicating the lack of screening to identify asymptomatic individuals. Furthermore, our previous study describing the development and use of diabetes registries in primary care networks in Alberta revealed similar issues to those reported here, including: the use of existing registries to recognize patients with T2D rather than proactively screen; relying on patient self-referral thereby limiting reach to patients engaged with the healthcare system; and limited relay of, or access to, clinical information [24].…”

Section: Discussionsupporting

confidence: 62%

Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

2020

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Background: Diabetes care is suboptimal in First Nations populations. Innovative and culturally-relevant approaches are needed to promote proactive organization of diabetes care for diabetes patients on-reserve in Canada. The Reorganizing the Approach to Diabetes care through the Application of Registries (RADAR) model is one strategy to improve care: an integrated disease registry and electronic health record for community healthcare workers with centralized care coordination. The aim of this study was to qualitatively assess the organization of type 2 diabetes care in participating communities in Alberta, Canada, at baseline prior to implementing RADAR.Methods: Using qualitative description, we purposefully sampled healthcare workers involved in diabetes care at each health center. We used the 5Rs framework (i.e., Recognize, Register, Resource, Relay, Recall) to inform the baseline assessment and conducted group interviews in 6 communities with 16 healthcare workers. Detailed notes were taken and validated by participants. Data was managed using ATLAS.ti 8 and analyzed using content analysis. Results: We found strong commitment and effort by local healthcare workers to support people living with type 2 diabetes in their communities. However, healthcare workers were limited in their ability to identify (i.e., recognize), track (i.e., register and relay) and manage (i.e., resource and recall) people with type 2 diabetes as proposed by the 5Rs framework. The organization of diabetes care was often reactive and dependent on patients' abilities to navigate the health system. Interestingly, participants talked about the 5Rs in relationship to one another, not in a linear or isolated manner. Conclusions: Overall, the organization of diabetes care in participating communities did not align with the recommended approach of the 5Rs framework. In addition, we propose "reimagining" the 5Rs to reflect the interdependence and mediation of components situated within human and financial resources. This will better equip healthcare workers to assess, plan and execute organized and proactive diabetes care. However, the onus on people living with type 2 diabetes to engage with healthcare services remains a concern. Trial registration: ISRCTN.com, ISRCTN14359671.

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Section: Discussionsupporting

confidence: 62%

Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

2020

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“…Given the large volume of data collected for our comprehensive evaluation (19), our findings related to the other RE-AIM dimensions are reported elsewhere, in previous (25) and accompanying papers (28,29). Here, we describe the implementation fidelity of the HEALD intervention at the organization assessment level, including the delivery of intervention components and provider satisfaction, to determine whether its execution influenced its effectiveness.…”

Section: Introductionmentioning

confidence: 84%

Contextualizing the Proven Effectiveness of a Lifestyle Intervention for Type 2 Diabetes in Primary Care: A Qualitative Assessment Based on the RE-AIM Framework

Wozniak

Soprovich

Mundt

et al. 2015

Canadian Journal of Diabetes

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“…It can be onerous for a site to access a specific medical record for periodic updates to the registry. 82 Additionally, errors in the mapping can lead a site to reference the wrong patient's record when updating the registry, thereby decreasing the accuracy of the data within the registry.…”

Section: Clinical Research Registries (Tessa Cook)mentioning

confidence: 99%

Why Is the Electronic Health Record So Challenging for Research and Clinical Care?

et al. 2021

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Background The electronic health record (EHR) has become increasingly ubiquitous. At the same time, health professionals have been turning to this resource for access to data that is needed for the delivery of health care and for clinical research. There is little doubt that the EHR has made both of these functions easier than earlier days when we relied on paper-based clinical records. Coupled with modern database and data warehouse systems, high-speed networks, and the ability to share clinical data with others are large number of challenges that arguably limit the optimal use of the EHR Objectives Our goal was to provide an exhaustive reference for those who use the EHR in clinical and research contexts, but also for health information systems professionals as they design, implement, and maintain EHR systems. Methods This study includes a panel of 24 biomedical informatics researchers, information technology professionals, and clinicians, all of whom have extensive experience in design, implementation, and maintenance of EHR systems, or in using the EHR as clinicians or researchers. All members of the panel are affiliated with Penn Medicine at the University of Pennsylvania and have experience with a variety of different EHR platforms and systems and how they have evolved over time. Results Each of the authors has shared their knowledge and experience in using the EHR in a suite of 20 short essays, each representing a specific challenge and classified according to a functional hierarchy of interlocking facets such as usability and usefulness, data quality, standards, governance, data integration, clinical care, and clinical research. Conclusion We provide here a set of perspectives on the challenges posed by the EHR to clinical and research users.

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Challenges in Identifying Patients with Type 2 Diabetes for Quality-Improvement Interventions in Primary Care Settings and the Importance of Valid Disease Registries

Cited by 9 publications

References 25 publications

Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

Contextualizing the Proven Effectiveness of a Lifestyle Intervention for Type 2 Diabetes in Primary Care: A Qualitative Assessment Based on the RE-AIM Framework

Why Is the Electronic Health Record So Challenging for Research and Clinical Care?

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