About: Grant Application
The Community Chronic Care Network (CCCN) was funded through a grant program of the Agency for Healthcare Research and Quality entitled Transforming Healthcare Quality Through Implementation Technology (THQIT). The purpose of the THQIT grant was to evaluate the effects of health information technology (HIT) on improving patient safety and quality of healthcare. The objective is to support organizational and community-wide implementation and diffusion of HIT and to assess the extent to which HIT contributes to measurable and sustainable improvement in patient safety, cost and overall quality of care. Research resulting from these grants should inform AHRQ, providers, patients, payers, policy makers, and the public about how HIT can be successfully implemented in diverse health care settings and lead to safer and better health for all Americans.
GRANT SUMMARY: The CCCN builds on a history of productive collaboration among Santa Cruz County's public, private, and not-for-profit health sectors. The participating organizations are: three community healthcare collaboratives (Health Improvement Partnership, Safety Net Clinic Coalition & Regional Diabetes Collaborative); two physician organizations (Physicians Medical Group & Sutter/Santa Cruz Medical Foundation); the County's Medicaid HMO (Central Coast Alliance for Health); the health department (Health Services Agency); a local community college (Cabrillo College); and a local philanthropy (Pajaro Valley Community Health Trust). The clinical entities, including the Physicians Medical Group, Sutter/Santa Cruz Medical Foundation, the Santa Cruz County Health Services Agency, the Safety Net Clinic Coalition, and the Central Coast Alliance for Health have agreed to share encounter/claim data, laboratory, and pharmacy data to populate a County-wide diabetes registry. The registry software was developed by Physicians Medical Group, whose Medical Director serves as the project's Principal Investigator. The existing registry is Web-based and interactive, giving providers options for improving the standard of diabetes care provided to patients. Prompts can remind physicians and medical assistants about needed tests at the point of care; the registry also can generate lists of patients overdue for exams or tests so that medical office staff can accelerate the appointment process. Because most of the data is captured electronically, the registry is populated with minimal burden within the office itself. Patients who change providers or health care plans can do so without losing their extensive histories of diabetes care; likewise, their providers potentially have immediate access to useful, accurate, and up-to-date information about their patients.
The immediate goal of the project is to extend the existing registry to as many County providers as possible. This will be accomplished in phases, by customizing training, reaching agreements among the organizations about sharing data, and piloting and launching the registry in increments. This, in turn, will make it possible to track the County's diabetes population in the aggregate, to identify trends in key indicators of care and control of this preventable but potentially devastating and costly disease.
Research in closed health care systems has demonstrated that use of this type of registry system in primary care settings improves clinical outcomes for persons with diabetes. The research purpose of this Project is to test a collaborative methodology for community-wide development and deployment of a diabetes registry and clinical guidelines in order that this proven practice can be replicated outside of a closed healthcare system.