# INTEGRATE-D: A pilot-test of implementation strategies to support integration of medical and psychosocial care for people with Type II Diabetes

> **NIH NIH R34** · OREGON HEALTH & SCIENCE UNIVERSITY · 2021 · $231,000

## Abstract

PROJECT SUMMARY
In 2016, the American Diabetes Association (ADA) published its first-ever recommendations for integrating
medical and psychosocial care (“integrated care”) for patients with Type II Diabetes Mellitus (DMII) and
common mental and behavioral health (MH/BH) problems. This landmark achievement has the potential to
greatly improve patient health. In the United States, 30 million people live with DMII, and the majority receive
care in primary care settings. By implementing the ADA recommendations, primary care practices will help
patients better manage their MH/BH needs, meet recommended goals for DMII management, and reduce the
risk of adverse outcomes. To implement ADA recommendations, practices must develop new skills, mobilize
treatment resources, identify care gaps, and adopt tools and processes that support systematic detection of
MH/BH status. Making these recommendations a routine part of practice is a major change, and it is critical to
understand how best to implement the ADA recommendations and test their effectiveness in the real world.
The proposal builds on a series of prior studies to develop and pilot test a package of implementation
strategies – called INTEGRATE-D – to support practices in implementing the ADA recommendations for
integrated DMII care, which involves systematic screening for and treatment of psychosocial (e.g., depression)
need. INTEGRATE-D combines the following evidence-based implementation strategies: (1) electronic health
record (EHR)-based support – to help align EHR use with ADA recommendations and enable screening for
depression, anxiety, diabetes distress, cognitive impairment, and self-management, and support identifying
and tracking progress on patient treatments and goals; (2) Audit and feedback – which involves assisting
practices in accessing clinically relevant, actionable data reports to inform measurement and identification of
care gaps in DMII and behavioral health care; (3) Skill-building resources – including training on ADA-
recommended care; and (4) Facilitation – to help implement the above strategies and the practice changes
needed to align care with ADA recommendations. The study aims are: Aim 1: Refine the INTEGRATE-D
intervention by incorporating preferences of stakeholders. In partnership with primary care key stakeholders
and experts, compile and refine the package of implementation strategies in the INTEGRATE-D intervention.
Aim 2: Demonstrate feasibility and acceptability. Conduct a mixed method, pre-post pilot comparing two
practices that receive the INTEGRATE-D intervention to two control practices that receive training materials
only. Based on pilot findings and input from experts and key stakeholders, we will refine INTEGRATE-D, and
design a pragmatic practice-based trial to study its effectiveness, implementation and ability to spread among
diverse practices.

## Key facts

- **NIH application ID:** 10089441
- **Project number:** 5R34DK124146-02
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** Deborah Jill Cohen
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $231,000
- **Award type:** 5
- **Project period:** 2020-02-01 → 2023-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10089441

## Citation

> US National Institutes of Health, RePORTER application 10089441, INTEGRATE-D: A pilot-test of implementation strategies to support integration of medical and psychosocial care for people with Type II Diabetes (5R34DK124146-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10089441. Licensed CC0.

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