The Collaborative program is a ‘complex intervention’ that has been shown to be effective. Which parts are the most important?
The recent TRANSLATE trial tested the effectiveness of a ‘multi-component organisational intervention’ for diabetes patients in primary care practices.
All practices in the study were provided with a report of their baseline measures and were instructed to target the same values.
In addition, intervention practices were supported by a clinical information system providing patient-speciﬁc clinical decision support and promoting proactive engagement of patients. Speciﬁc components were directed to the patient, the physician, and the clinic staff.
The particular components of the intervention correlate with many of the change ideas used in our chronic disease management collaboratives. Happily, they produce the acronym TRANSLATE.
- Target high risk - identify and begin with patients at highest risk.
- Registry- Create a registry for data collection, reporting, and support.
- Administration – Set up administration to oversees changes in roles and
responsibilities and enhance continuity during staff turnover.
- Notify and remind – Notify patients of targets and appointments. Remind providers at time of visit with patient-speciﬁc alerts.
- Site coordinator- Identify a site coordinator to facilitate the clinic operations.
- Local physician champion - Identify a lead provider to work with the site coordinator and facilitate the intervention with colleagues.
- Audit and feedback Audit and review monthly. Provide feedback to improve progress.
- Track Track process measures, outcomes, and operational activity.
- Education Educate and update all staff in diabetes management techniques.
The results were impressive. All pratices (control and intervention) significantly increased process measures – but only intervention practices significantly improved clinical outcomes, and this was achieved to high significance in a composite blood pressure, LDL and HbA1c measure.
The conclusion –
‘this combination of components provides a proven strategy for initiating improvement in clinical diabetes care for many primary care practices.’
How about another S for Sharing the stories.
TRANSLATES may have produced even better outcomes than TRANSLATE.
Or a C for Collaboration. Acronym anyone? Leave your suggestion in the comments below.