A practical randomized trial to improve diabetes care

Abstract

Patients are very willing to participate in a brief computer-assisted intervention that is effective in enhancing quality of diabetes care. Staff in primary care offices can consistently deliver an intervention of this nature, but most physicians were unwilling to participate in this translation research study.

Effectiveness of Interventions to Promote Screening for Diabetic Retinopathy

“…Hand searches did not yield additional studies. Forty-eight eligible studies with seven companion papers [65][66][67][68][69][70][71] were identified, including 12 RCTs, 18,21,30,32,35,39,40,44,[52][53][54]56 four nonrandomized studies, 23,29,31,38 and 32 pre-post studies. 17,19,20,22,24 -28,33,34,36,37,41-43,45-51,55,57-64 The 48 studies had a total of 162,157 participants (range, 30 to 27,270) and follow-up periods ranging from 4 months to 4 years.…”

“…Attrition ranged from 0% to 14.9% among the seven studies reporting these data. 19,28,32,39,40,43,53 The leading sources of attrition were as follows: (1) moved out of the area, (2) death, (3) poor health, (4) loss of interest, and (5) transportation difficulties. Table 2 shows the intervention focus, the RRs, and absolute retinal screening rates for each study.…”

“…Table 2 shows the intervention focus, the RRs, and absolute retinal screening rates for each study. Among RCTs, five studies focused on patients and population, 21,35,44,56,65 five studies focused on the healthcare system, 30,39,40,52,54 one study focused on both patients and providers, 32 and one study focused on both patients and the healthcare system. 53 Among studies with designs other than RCTs, 14 focused on the healthcare system infrastructure and processes, 17,19,24,29,36,[41][42][43]49,55,57,58,60,62 five on patients or population, 28,34,51,63,64 and four on provider and practice.…”

“…50 Among RCTs, only two studies had multiple foci. One focused on both patients and providers (RR 1.13 [95% CIϭ1.04 -1.22]) 32 and another focused on both patients and the system (RR 1.30 [95% CIϭ1.12-1.50]). 53 Among studies with nonrandomized study designs and multiple foci, eight of nine that focused on both patients and providers demonstrated significantly increased screening 20,22,[25][26][27]31,38,46,47 ; the RR ranged from 1.15 (95% CIϭ1.08 -1.23) 27 to 4.16 (95% CIϭ3.…”

“…32,51,52 These components also support administrative measures in quality improvement, because they provide an efficient mechanism for tracking and monitoring the successful delivery of health care. 32,51,52 The wide application of electronic medical record systems and electronic management systems 18,23,35,41,53,54 have facilitated this implementation of these components, although a registry and a basic paper tracking mechanism can also be used. 23 A simple physician feedback tool with a paper checklist worked efficiently in one setting to improve the rate of retinal screening.…”