A Systems Engineering Analysis of Opportunities for Pharmacists on Diabetes Care Teams

Diabetes is one of the most significant global healthcare challenges of the 21st century: it is estimated that one in three adults will have diabetes in the United States in the year 2050. As a result, healthcare organizations are integrating systemic changes to address the needs of expanding chronic care patient population, including shifting towards a patient-centered medical home philosophy and introducing new health information technology tools to help share the workload for diabetes care activities. Advanced educational opportunities, collaborative-practice agreements, and a shifting model towards community-based care clinics affords opportunities for pharmacy professionals to participate in a more central role on the diabetes care team.

This dissertation work explores the intersection of diabetes care coordination and health information technology (IT), with a specific focus on the potential for pharmacist involvement on the diabetes care team. Studies I and II aimed to define the existing diabetes care team as a system, with identifying the specific roles, information flows, tasks, and temporal and geospatial attributes for providing effective care. Study I used a questionnaire and social network analysis tools to identify the key members of the diabetes care team. The results indicated that these team members were the primary care provider, endocrinologist, nurse, pharmacist, dietitian, and social worker. Study II used semi-structured interviews and team task analysis for thirty (N=30) diabetes care team member participants (N=5 for each category indicated in Study I). The results from Study II led to the creation of a new systems engineering analytical framework, titled Diabetes care Roles Information Flows and Team Coordination (DRIFT). This framework expanded existing chronic care and healthcare systems engineering frameworks through the inclusion of granularity, temporal, and sociotechnical factors in a three-dimensional systems model. Study II also provided confirmatory support for the inclusion of pharmacists for sharing more care coordination activities on diabetes care teams.

The results from studies I and II were synthesized to identify potential engineering health IT solutions to gaps in diabetes care activities. The results synthesis was the foundation of a new health IT system prototype, eVincio, developed by the author for this dissertation work. eVincio is comprised of a patient-facing mobile application and a provider-facing desktop software that worked together to help healthcare professionals visualize patient care activities via the DRIFT analytical framework. Study III was a formative usability assessment of the eVincio prototypes with six (N=6) pharmacist participants. Results revealed that eVincio could be very beneficial for helping healthcare professionals visualize patient care activities and identify gaps in care coordination, particularly for professionals who work as case managers, population health analysts, or have some aspect of quality monitoring in their role. As the eVincio system is still in a prototype stage of development, additional studies need to be conducted to determine system requirements for interoperability, evidence-based guidelines, and fulfilling end-user requirements.