Adoption and implementation of mandated diabetes registries by community health centers.
BACKGROUND
Innovations adopted by healthcare organizations are often externally mandated. However, few studies examine how mandated innovations progress from adoption to sustained effective use. This study uses Rogers's model of organizational innovation to explore community health centers' (CHCs') mandated adoption and implementation of disease registries in the federal Health Disparities Collaborative (HDC).


METHODS
Case studies were conducted on six CHCs in North Carolina participating in the HDC on type 2 diabetes mellitus. Data were collected from semistructured interviews with key staff, and from site-level and individual-level surveys.


RESULTS
Although disease registry adoption and implementation were mandated, CHCs exercised prerogative in the timing of registry adoption and the functions emphasized. Executive and medical director involvement, often directly on the HDC teams, was the single most salient influence on adoption and implementation. Staff members' personal experience with diabetes also provided context and gave registries added significance. Participants lauded HDC's technique of small-scale, rapid-cycle change, but valued even more shared problem solving and peer learning among HDC teams. However, lack of cross-training, inadequate resources, and staff turnover posed serious threats to sustainability of the registries.


CONCLUSIONS
The present study illustrates the usefulness of Rogers's model for studying mandated innovation and highlights several key factors, including direct, personal involvement of organizational leadership, and shared problem solving and peer learning facilitated by the HDC. However, these six CHCs elected to participate early in the HDC, and may not be typical of North Carolina's remaining CHCs. Furthermore, most face important long-term challenges that threaten routinization.
Helfrich
Christian D
CD
Health Services Research and Development Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98101, USA. christian.helfrich@va.gov
Savitz
Lucy A
LA
Swiger
Kathleen D
KD
Weiner
Bryan J
BJ
D003151:Community Health Centers / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000628:therapy; D004059:Diffusion of Innovation; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D019221:Mandatory Reporting; D017146:Models, Organizational; D009657:North Carolina; D019982:Organizational Case Studies; D009936:Organizational Innovation; D011340:Problem Solving; D036301:Qualitative Research; D012042:Registries