Table 1 Specification of the SPARC intervention strategy

Actors

Peer mentors: clinicians who have implemented and maintained a diabetes registry in their practice

Physician informaticists: clinicians with expertise in primary care data systems and reporting

Actions

1) Two champion meetings

• Provide education to intervention and control practices on how to implement a diabetes registry, including:

− Registry development

− Population health in primary care delivery

− The American Diabetes Association’s guidelines for patients with diabetes

− Diabetes registry software options or communicating with EHR vendors about registry functionality

− A practice self-assessment checklist designed to help practices plan and manage potential workflow changes

• Facilitate discussion among intervention practices about the challenges faced during registry implementation and solutions developed to overcome those challenges

• Provide intellectual space for intervention practices to process what they are learning and talk about their experiences with registry implementation, as well as develop a plan for sustaining or expanding their registry

2) Peer mentoring

• Advise intervention practices on registry implementation and using the materials disseminated at champion meetings.

• Provide intervention practices with access to physician informaticists to assist with use of practice data systems.

Target of the actions

Practice champions: two champions from each intervention and control practice—one clinician champion and one champion who will be a potential user of a registry—will attend the champion meetings. Champions in intervention practices will work with the peer mentor.

Temporality and dose

1) Champion meetings

• One champion meeting will be held before the intervention period and a second about 15 months later.

2) Peer mentoring

• Peer mentors will work with practice champions in intervention practices for the first 12 months of the intervention, maintaining monthly communication through telephone calls and practice visits.

Implementation outcome(s) effected

Change in mean patient hemoglobin A1c scores

Justification

We believe that helping practices use existing resources and learn how to solve problems to implement a diabetes registry and related workflow changes will be more sustainable than implementation strategies that rely more heavily on external resources.