November 17, 2017: ICD-Pieces: From Planning to Performance


Miguel A. Vazquez, MD
Professor of Medicine
Clinical Chief Nephrology Division
University of Texas Southwestern Medical Center

George Oliver, MD
Vice President Clinical Informatics
Parkland Center for Clinical Innovation


ICD-Pieces: From Planning to Performance


Pragmatic clinical trial; Multiple chronic conditions; Diabetes; Hypertension; Chronic kidney disease; Pieces™; Parkland Center for Clinical Innovation; PCCI; University of Texas Southwestern Medical Center; Electronic health records

Key Points

  • ICD-Pieces is a pragmatic clinical trial conducted in 4 large, diverse healthcare systems, including a Veterans Affairs (VA) system.
  • This study is evaluating a collaborative care model for improving the management of 3 chronic conditions: diabetes, hypertension, and chronic kidney disease. This model of care combines a novel IT platform, primary care practitioners, and site practice facilitators.
  • The study is conducted with the aid of clinical decision support tools, previsit planning, performance monitoring, and outcomes ascertainment through EHR data and claims data.

Discussion Themes

It is essential to engage key stakeholders early and throughout the pragmatic trial to sustain enthusiasm for the trial’s outcomes. In ICD-Pieces, it was especially important to engage with individual healthcare practitioners to facilitate and simplify their workflow. The study team also collaborated with medical directors and other leaders at the participating healthcare systems.

Practice facilitators at each study site served as a link between the study team and the healthcare system operations.

As with many real-world pragmatic trials, ICD-Pieces needed to address some turnover of key study participants, including principal investigators, practice facilitators, and IT staff.

For More Information

Read more about the ICD-Pieces trial in the Living Textbook.

Dr. Vazquez discusses lessons learned in ICD-Pieces:

Visit the ICD-Pieces Demonstration Project page:

For more on dissemination, implementation & sustainability for ICD-Pieces click here.


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