September 23, 2016: ICD-Pieces: Early Implementation and Progress

September 23, 2016: ICD-Pieces: Early Implementation and Progress


ICD-Pieces: Early Implementation and Progress


Miguel Vazquez, MD, Professor, Department of Internal Medicine, University of Texas, Southwestern Medical Center, and Medical Director of Transplantation at St. Paul University Hospital

George (Holt) Oliver, MD, PhD, Vice President of Clinical Informatics at Parkland Health and Hospital System, UT Southwestern


Multiple chronic conditions; Comorbidity; Chronic kidney disease; Diabetes; Hypertension; High blood pressure; Clinical informatics; Pragmatic clinical trial; Electronic health record; Cluster randomization

Key Points

  • Improving Chronic Disease Management with Pieces™ (ICD-Pieces) is a pragmatic clinical trial involving the care of patients with multiple chronic conditions: chronic kidney disease, diabetes, and hypertension.
  • In the ICD-Pieces trial, patients receive care in a collaborative model of primary/subspecialty care enhanced by novel information technology and the use of clinical practice facilitators (e.g., pharmacist, nurse practitioner, population specialist). The aim is to evaluate whether patients who receive this collaborative care have fewer hospitalizations, readmissions, ER visits, cardiovascular events and deaths than patients receiving standard medical care.
  • ICD-Pieces takes place across four diverse healthcare systems (public, private, federal), each with their own EHR infrastructure. The trial employs a stratified cluster randomization by healthcare system with the unit of randomization being the clinical practice.
  • The centralized, cloud-based Pieces technology provides IT security, standardized patient identification, and clinical decision support for the participating healthcare systems.

Discussion Themes

Regular communication with each site’s healthcare team is essential. The practice facilitators help with the intervention protocols and workflows.

Will cost effectiveness data be collected? How will the total cost of care be evaluated?

For More Information

Visit the ICD-Pieces demonstration project’s webpage:

#PCORnet, #pctGR
@PCTGrandRounds, @Collaboratory1, @PCORnetwo