DESCRIPTION (Provided by the Applicant): Diabetes care in the U.S. consistently fails to meet recommended quality standards. Barriers impede the translation of evidence-based guidelines into sustainable practice. Few studies have considered multiple barriers, and there is a lack of evidence-based strategy in choosing interventions to overcome barriers. This proposal involves a comprehensive assessment of practice barriers to diabetes guidelines adherence across a primary care network. A Barrier Assessment Tool (BAT) based upon a framework proposed by Cabana, et al. (1999) will be validated to correlate with provider and practice adherence to diabetes care guidelines. A Diabetes Flow Sheet implemented in our Network to track adherence to guidelines will be assessed and correlated with measured barriers. This organizational strategy will support an evidence-based approach to quality initiative interventions. The BAT will be administered to practice team members: providers, support staff, and practice managers in our network of 25 primary care practices. Five hypotheses are tested: A: The BAT measures perceived barriers to adherence to diabetes guidelines, while showing adequate internal consistency and an identifiable subscale structure. B: The BAT results inversely correlate with practice and provider adherence to ADA guidelines. C: BAT scores will inversely correlate with use of the Diabetes Flow Sheet. D: The BAT scores inversely correlate with clinical outcomes (glycemic and lipid control.) E: Use of the Diabetes Flow Sheet correlates with higher provider & practice adherence to ADA guidelines. The BAT would then provide the structure for comprehensive assessment of barriers. Study of the effectiveness of interventions targeted to barriers would be the next step in future projects and research. The Crozer-Keystone PBRN is a real-world laboratory for research in the translation of evidence into diverse practices. The Network became an AHRQ-funded PBRN in 2002 and has just completed a randomized intervention in the care of chronic disease patients. The Crozer-Keystone Health Network Quality Committee infrastructure has historically supported guideline adherence and diffusion of evidence-based medicine into practices. The Network is optimally positioned to implement and study this proposed organizational strategy.