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. 2012 Jan 23:7:6.
doi: 10.1186/1748-5908-7-6.

Increasing efficacy of primary care-based counseling for diabetes prevention: rationale and design of the ADAPT (Avoiding Diabetes Thru Action Plan Targeting) trial

Devin M Mann  1 , Jenny J Lin
Affiliations

Increasing efficacy of primary care-based counseling for diabetes prevention: rationale and design of the ADAPT (Avoiding Diabetes Thru Action Plan Targeting) trial

Devin M Mann et al. Implement Sci. .

Abstract

Background: Studies have shown that lifestyle behavior changes are most effective to prevent onset of diabetes in high-risk patients. Primary care providers are charged with encouraging behavior change among their patients at risk for diabetes, yet the practice environment and training in primary care often do not support effective provider counseling. The goal of this study is to develop an electronic health record-embedded tool to facilitate shared patient-provider goal setting to promote behavioral change and prevent diabetes.

Methods: The ADAPT (Avoiding Diabetes Thru Action Plan Targeting) trial leverages an innovative system that integrates evidence-based interventions for behavioral change with already-existing technology to enhance primary care providers' effectiveness to counsel about lifestyle behavior changes. Using principles of behavior change theory, the multidisciplinary design team utilized in-depth interviews and in vivo usability testing to produce a prototype diabetes prevention counseling system embedded in the electronic health record.

Results: The core element of the tool is a streamlined, shared goal-setting module within the electronic health record system. The team then conducted a series of innovative, "near-live" usability testing simulations to refine the tool and enhance workflow integration. The system also incorporates a pre-encounter survey to elicit patients' behavior-change goals to help tailor patient-provider goal setting during the clinical encounter and to encourage shared decision making. Lastly, the patients interact with a website that collects their longitudinal behavior data and allows them to visualize their progress over time and compare their progress with other study members. The finalized ADAPT system is now being piloted in a small randomized control trial of providers using the system with prediabetes patients over a six-month period.

Conclusions: The ADAPT system combines the influential powers of shared goal setting and feedback, tailoring, modeling, contracting, reminders, and social comparisons to integrate evidence-based behavior-change principles into the electronic health record to maximize provider counseling efficacy during routine primary care clinical encounters. If successful, the ADAPT system may represent an adaptable and scalable technology-enabled behavior-change tool for all primary care providers.

Trial registration: ClinicalTrials.gov Identifier NCT01473654.

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Figures

Figure 1
Figure 1
Theoretical components of the ADAPT system. ADAPT = Avoiding Diabetes Thru Action Plan Targeting.
Figure 2
Figure 2
Elements of the ADAPT system. ADAPT = Avoiding Diabetes Thru Action Plan Targeting; EHR = electronic health record.
Figure 3
Figure 3
Screenshot of test patient ADAPT goals flowsheet at a hypothetical baseline visit. ADAPT = Avoiding Diabetes Thru Action Plan Targeting.
Figure 4
Figure 4
Screenshot of ADAPT bundled order set. ADAPT = Avoiding Diabetes Thru Action Plan Targeting.
Figure 5
Figure 5
Flow design for ADAPT randomized controlled trial. ADAPT = Avoiding Diabetes Thru Action Plan Targeting; RA = research assistant; EHR = electronic health record.
Figure 6
Figure 6
Screenshot of ADAPT website feedback display. ADAPT = Avoiding Diabetes Thru Action Plan Targeting.
See this image and copyright information in PMC

References

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