"Assessing Barriers to ADA Guideline Adherence"

Study hypothesis: Questionnaire responses about perceived barriers to implementation of
diabetes care recommendations, administered to primary care providers and staff, will be
shown to correlate with that provider's and practice's success at implementing care
guidelines.

Diabetes care in the U.S. consistently fails to meet recommended quality standards. Barriers
impede the translation of evidence-based guidelines into sustainable practice. Few studies
have considered multiple barriers, and there is a lack of evidence-based strategy in
choosing interventions to overcome barriers. This study involves a comprehensive assessment
of practice barriers to diabetes guidelines adherence across a primary care network. The BAT
based upon a framework proposed by Cabana, et al (1999) will be validated to correlate with
provider and practice adherence to diabetes care guidelines. A Diabetes Flow Sheet
implemented in our Network to track adherence to guidelines will be assessed and correlated
with measured barriers. This organizational strategy will support an evidence-based approach
to quality initiative interventions. The BAT will be administered to practice team members:
providers, support staff, and practice managers in our Network of 25 primary care practices.
Five hypotheses are tested:

A: The BAT measures perceived barriers to adherence to diabetes guidelines, while showing
adequate internal consistency and an identifiable subscale structure.

B: The BAT results inversely correlate with practice and provider adherence to ADA
guidelines.

C: BAT scores will inversely correlate with use of the Diabetes Flow Sheet.

D: The BAT scores inversely correlate with clinical outcomes (glycemic and lipid control.)

E: Use of the Diabetes Flow Sheet correlates with higher provider and practice adherence to
ADA guidelines.

The BAT would then provide the structure for comprehensive assessment of barriers. Study of
the Crozer-Keystone PBRN is a real-world laboratory for research in the translation of
evidence into diverse practices. The Network is optimally positioned to implement and study
this organizational strategy.

Inclusion Criteria:

- Crozer-Keystone Health Network primary care (Internal Medicine and Family Medicine)
providers and support staff in the 25 primary care practices.