BACKGROUND/RATIONALE:
It is difficult to determine from available research what organizational strategies work best for chronic illness care due to methodological problems, lack of published details, and difficulties in accessing relevant evidence in bibliographic and grant databases.

OBJECTIVE(S):
Objective 1: a systematic review of research evidence to identify effective organizational interventions to implement clinical evidence for high priority chronic illnesses relevant to the VA [SynERGI]. Objective 2: a database (GUIDE) of research in progress to track new studies of organizational interventions to implement clinical evidence.

METHODS:
Systematic review of published and in progress research of interventions explicitly targeting organizational structures or processes using: a modified taxonomy from the EPOC which was mapped onto the Chronic Care Model (CCM) for coding; a highly sensitive search strategy using disease-specific terms that is generalizable to any disease; and a detailed, iterative group process to develop explicit disease-specific inclusion and exclusion criteria.

FINDINGS/RESULTS:
SynERGI: Medline searches through 7/17/2008 identified 27,341 potentially relevant citations. Disease-specific eligible studes for each of the following VA-relevant diseases are: DM (total citations:eligible studies; 8,127:52); COPD (1,979:10); CHF (2,559:30); colorectal cancer (1,480: 0); Depression (3,707; 19); SCI (359:0); and HIV (1,988:3). For abstractions to date, delivery system redesign was the most frequently used "organizational" CCM element (97 trials), compared to information system support (53 trials) and health care system support (17 trials). Use of different CCM organizational strategies varied greatly across the different illnesses, and was most frequent in diabetes, followed by CHF trials. The most frequently used combination of CCM elements was delivery system redesign + patient self-management support (28 trials). The majority of interventions were multi-component and averaged 3 strategies per study. No trial used all 6 CCM elements; the most used in any single trial was 4. GUIDE: Searches of the ClinicalTrials.gov website to identify research in progress using organizational interventions identified 3,399 potentially relevant active trials in CY2006. Of these, 83 met eligibility criteria: multidisease-20; IHD-39; diabetes-33; depression-10; CHF-9; COPD-9; and HIV-6. Among eligible trials, most (57, 68%) used delivery system redesign, 43 (51%) used information system support, and 4 (0.5%) utilized health care system support. Potentially eligible citations in 2007 were: IHD (696 total: 62 potentially eligible); COPD (42:8); HIV (88:10); depression (122:25); diabetes (228:22); and CHF (43:9).

IMPACT:
Results will allow researchers and clinicians to more easily identify innovative cutting-edge organizational research to improve healthcare and inform QUERI and QI efforts within the VA.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Leykum LK, Pugh J, Lawrence V, Parchman M, Noël PH, Cornell J, McDaniel RR. Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes. Implementation science : IS. 2007 Aug 28; 2:28. [view]
2. Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR. The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure. Implementation science : IS. 2010 Aug 25; 5:66. [view]

Conference Presentations

1. Beard AJ, Klamerus ML, Hofer TP, Downs JR, Lucatorto M, Holleman R, Kerr EA. Assessing Appropriateness of Lipid Management among Patients with Diabetes. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; National Harbor, MD. [view]
2. Lawrence VA, Pugh JA, Noel PH, Parchman M, Best RG. Creating SynERGI through Organizational Intervention to Implement CPGs for QUERI Diseases [workshop]. Paper presented at: VA QUERI National Meeting; 2003 Dec 1; Washington, DC. [view]
3. Leykum LK, Pugh J, Lawrence VA, Parchman M, Cornell J, McDaniel R. Making sense of organizational interventions using complexity science. Poster session presented at: AcademyHealth Annual Research Meeting; 2006 Jan 1; Seattle, WA. [view]
4. Leykum L, Lawrence V, Parchman M, Noel P, Pugh J, Cornell J, McDaniels R. Making sense of organizational interventions using complexity science. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2007 Apr 26; Toronto, Canada. [view]
5. Mortensen EM, Leykum L, Noel PH, Zeber JE, Pugh MJ, Lawrence VA. Organizational interventions to improve outcomes for patients with COPD. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2007 Apr 26; Toronto, Canada. [view]
6. Leykum L, Pugh JA, Lawrence VA, Noel PH, Parchman ML, McDaniel R. Use of complexity science improved effectiveness of organizational interventions for patients with congestive heart failure. Poster session presented at: AcademyHealth Annual Research Meeting; 2007 Jun 4; Orlando, FL. [view]
7. Noel PH, Lawrence VA, Cornell JE, Arar NH, Leykum L, Mortensen EM, Pugh MJ, Bollinger M, Parchman ML. Use of Organizational Interventions to Improve Chronic Illness Care: Utilization of Chronic Care Model Elements. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD. [view]

DRA: Health Systems
DRE: none
Keywords: Clinical practice guidelines
MeSH Terms: none