title: Challenges in Identifying Patients with Type 2 Diabetes for Quality-Improvement Interventions in Primary Care Settings and the Importance of Valid Disease Registries.
abstract: OBJECTIVE
  Patient registries are considered an important foundation of chronic disease management, and diabetes patient registries are associated with better processes and outcomes of care. The purpose of this article is to describe the development and use of registries in the Alberta's Caring for Diabetes (ABCD) project to identify and reach target populations for quality-improvement interventions in the primary care setting.
  
  
  METHODS
  We applied the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework and expanded the definition of reach beyond the individual (i.e. patient) level to include the ability to identify target populations at an organizational level. To characterize reach and the implementation of registries, semistructured interviews were conducted with key informants, and a usual-care checklist was compiled for each participating Primary Care Network (PCN). Content analysis was used to analyze qualitative data.
  
  
  RESULTS
  Using registries to identify and recruit participants for the ABCD interventions proved challenging. The quality of the registries depended on whether physicians granted PCN access to patient lists, the strategies used in development, the reliability of diagnostic information and the data elements collected. In addition, once a diabetes registry was developed, there was limited ability to update it.
  
  
  CONCLUSIONS
  Proactive management of chronic diseases like diabetes requires the ability to reach targeted patients at the population level. We observed several challenges to the development and application of patient registries. Given the importance of valid registries, strong collaborations and novel strategies that involve policy-makers, PCNs and providers are needed to help find solutions to improve registry quality and resolve maintenance issues.
authors.affiliation: ACHORD, University of Alberta, Edmonton, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wozniak
authors.affiliation: ACHORD, University of Alberta, Edmonton, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Soprovich
authors.affiliation: ACHORD, University of Alberta, Edmonton, Canada; Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rees
authors.affiliation: ACHORD, University of Alberta, Edmonton, Canada; Centre for Nursing and Health Studies, Athabasca University, Edmonton, Canada.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Johnson
authors.affiliation: ACHORD, University of Alberta, Edmonton, Canada; Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: ACHORD, University of Alberta, Edmonton, Canada; Department of Public Health Sciences, University of Alberta, Edmonton, Canada. Electronic address: jeff.johnson@ualberta.ca.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*; D012042:Registries
keywords: RE-AIM; diabète de type 2; health program evaluation; panel management; patient registry; prise en charge d’un regroupement de patients; registre de patients; type 2 diabetes; évaluation des programmes sanitaires