Using Practice Facilitation and Operationalizing Referral Information Technology (UP FOR IT) to Increase DSMES Utilization

ABSTRACT The prevalence of diabetes in Kentucky is nearly 25% higher than the national average and rural areas within Kentucky face an even higher burden of diabetes and its related complications. Diabetes self-management education and support (DSMES) services are integral to quality diabetes care. Substantial evidence shows that DSMES participation improves glycemic control, decreases diabetes complications, reduces mortality, improves quality of life and is cost-effective. Despite strong evidence of benefit and clear guidelines from the American Diabetes Association recommending its use, only 10% of eligible individuals complete DSMES. In response to the current RFA seeking to test innovative and pragmatic approaches to facilitate greater use of DSMES, we propose implementing automated patient identification and a bidirectional referral system to reduce barriers related to identification and referral of eligible patients and using practice facilitation to increase clinician awareness and buy-in. We have partnered with the Kentucky Department of Public Health (a statewide provider of free, in-person and online DSMES), the Kentucky Regional Extension Cooperative (practice facilitation partner), Kentucky Health Information Exchange (health information technology partner) and four healthcare systems in rural Kentucky. We will use a pragmatic cluster randomized study design to evaluate implementation effectiveness and will use an implementation science framework (PRISM) to guide evaluation of the feasibility, acceptability, and sustainability of the intervention. This pilot and feasibility study will provide insight on pragmatic, scalable strategies to increase DSMES utilization. Findings will generate key preliminary data that will guide planning of an R01-level dissemination and implementation trial with the goal of reducing diabetes-related morbidity and mortality.