Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is working to make information about patients’ risk for diabetes part of patients’ shared decision making discussions with their clinicians.

More than 84 million Americans are at risk for developing diabetes. Understanding this risk can help patients and clinicians work together to decide on a prevention approach.

Implementation Project Summary

What is the goal of this implementation project?

Medicine and lifestyle changes, such as healthy eating and exercise, can help prevent diabetes. But these approaches work better for some people than others. A PCORI-funded study found that people at high risk for diabetes benefited most from taking medicine and making lifestyle changes. People at low risk saw little or no benefit from these approaches. Based on the study’s findings, a PCORI-funded implementation project developed a way to predict a person’s risk of developing diabetes based on data from their health record.

This project is making the risk information part of shared decision making, or SDM, discussions to help patients who are at risk for diabetes and their clinicians to decide on preventive care.

What will this project do?

The project team is working with 39 primary care clinics in two health systems. The team is adding a risk prediction tool to an existing SDM approach. Then they are working to make the SDM approach part of regular care.

In the SDM approach, staff such as pharmacists and nurses who work in the clinics meet with patients at risk for diabetes. They discuss the patient’s risk for diabetes based on the prediction tool. They share information about how lifestyle changes and a medicine called metformin can help prevent diabetes. The staff member helps the patient choose a prevention approach that works for them. The staff member also follows up with the patient’s primary care clinician to let them know about the patient’s choice.

To put the risk prediction tool in place, the project team is:

  • Building the tool into the health systems’ patient records systems so that it can identify patients at risk for diabetes
  • Training nurses, pharmacists, care coordinators, and primary care providers to use the tool and talk about diabetes risk in SDM sessions
  • Including nurse and physician champions at each primary care clinic to promote the use of the tool
  • Giving clinicians feedback about patients’ health outcomes

The project team is also a creating a guide to help other health systems use the tool in the future.

What is the expected impact of this project?

This project will demonstrate what is required to make the risk prediction tool part of SDM in standard primary care. Through the project, more than 4,700 patients will have access to personalized information about their risk for diabetes when working with their clinician to come up with a plan to prevent diabetes.

The project evaluation will confirm that patients and clinicians can use the risk prediction tool and the SDM approach as intended. It will also track patients’ health outcomes.

More about this implementation project:

Stakeholders Involved in This Project

  • Leadership at UCLA and Intermountain Healthcare
  • Healthwise
  • American Medical Association
  • National Patient Advocate Foundation
  • American Diabetes Association

Implementation Strategies

  • Promote shared decision making.

  • Use a clinical decision support tool.
  • Adapt the shared decision making approach to include a risk prediction tool and to work for sites’ existing resources, staffing, and workflows.
  • Integrate a risk prediction tool and electronic referral process into sites’ electronic health record systems and patient registries.
  • Provide sites with tools to support implementation, including structured note templates for documenting shared decision making sessions and reports on clinical outcomes.
  • Provide educational materials to patients, as part of decision aid.
  • Train nurses, pharmacists, care coordinators, and primary care providers on how to use the risk tool and to have shared decision making discussions with patients.
  • Identify and prepare nurse and physician champions at sites.
  • Provide technical assistance to sites.
  • Develop an implementation guide to support further use of the shared decision making approach at other sites.

Evaluation Outcomes

To document implementation:

  • Number and proportion of eligible individuals who are invited and who participate in an SDM session
  • Number and duration of SDM sessions
  • Fidelity of implementation protocol

To assess healthcare and health outcomes:

  • Change in patient weight
  • Change in patient systolic blood pressure
  • New uptake of metformin
  • Whether shared decision making occurred (CollaboRATE)

Project Information

O. Kenrik Duru, MD, MS
Carol Mangione, MD, MS
The Regents of the University of California, Los Angeles
$1,730,722
Using Personalized Risk/Benefit Profiles in SDM for Diabetes Prevention

Key Dates

March 2019
June 2022
2019

Study Registration Information

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Pilot Project: Predicting Who Will Respond Best to Medical Treatments.

Related Dissemination and Implementation Project

Improving Diabetes Prevention Based on Predicted Benefits of Treatment

Tags

Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Project Details Type
Last updated: April 23, 2022