SPREAD-NET: PRactices Enabling Adapting and Disseminating in the Safety NET

The investigators propose to compare the effectiveness of 3 support strategies for optimizing
the sustainable implementation of the evidence-based ALL intervention. To do so, the
investigators will randomize 30 community health centers (CHCs) to receive 1 of 3
implementation support strategies: Low support (toolkit only), Medium (toolkit, staff
training), High (toolkit, training, on-site facilitation). The study aims are as follows:

Aim 1: Compare the effectiveness of the 3 strategies (low, medium, high intensity) at
supporting CHCs' implementation of the ALL intervention, through a cluster-randomized trial.

Hypothesis: Clinics randomized to receive more implementation support will be more likely
than those randomized to receive less support (high>medium>low) to significantly improve the
percent of their patients with (i) guideline-appropriate prescriptions for ACE/ARBs and
statins, and (ii) last blood pressure (BP) and low-density lipoprotein (LDL) under control).

Aim 2: Assess how effectively the 3 strategies support intervention sustainability at 12, 24
and 36 months post-implementation, measured as maintenance of change over time (outcomes as
in Aim 1).

Hypothesis: Clinics randomized to receive more implementation support will be more likely to
maintain changes in the outcomes of interest.

Aim 3: Identify clinic characteristics associated with the support strategies' effectiveness
(e.g. decision-making structures, leadership support, team processes / characteristics,
readiness and capacity for change).

Research questions: What are the characteristics of clinics that achieve sustained change
even with less implementation support, and of those that do not achieve change even with more
support?

Inclusion Criteria:

- Convenience sample, all patients with Diabetes Mellitus from 30 community health
clinics (CHCs) that are members of OCHIN, Inc.

Exclusion Criteria:

- Patients without diagnosed DM