Improving Diabetes Care in Practice

Peterson, Kevin; Radosevich, David M.; O’Connor, Patrick J.; Nyman, John A.; Prineas, Ronald J.; Smith, Steven A.; Arneson, Thomas J.; Corbett, Victor A.; Weinhandl, Joyce C.; Lange, Carol; Hannan, Peter J.

doi:10.2337/dc08-2034

Cited by 116 publications

(146 citation statements)

References 22 publications

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“…These negative findings highlight the importance of delivering decision support information that is both timely and actionable. Another study in 24 practices in Minnesota, which included a case manager function, showed improvements in both process and outcome 15 . Other interventions have resulted in improvement in process but not laboratory outcomes 8,10,16 .…”

Section: Discussionmentioning

confidence: 99%

“…Interventions that add personnel 15,45,46 . Our study findings support the idea that practices interested in population-based chronic disease management may consider a laboratory-based registry and decision support system as a transition to a more fully integrated future including a broader team and improved electronic systems.…”

Section: Discussionmentioning

confidence: 99%

“…The Chronic Care Model highlights the importance of a population-based approach; involving community, patients and providers; and information technology [4][5][6] . Various combinations of population management, practice support, and patient outreach have been used for diabetes care in a variety of settings with mixed results [7][8][9][10][11][12][13][14][15][16] . Many practice interventions for diabetes have been carried out in academic and urban centers.…”

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confidence: 99%

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The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

et al. 2009

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BACKGROUND:Optimal care for patients with diabetes is difficult to achieve in clinical practice. OBJECTIVE:To evaluate the impact of a registry and decision support system on processes of care, and physiologic control.PARTICIPANTS: Randomized trial with clustering at the practice level, involving 7,412 adults with diabetes in 64 primary care practices in the Northeast. INTERVENTIONS:Provider decision support (reminders for overdue diabetes tests, alerts regarding abnormal results, and quarterly population reports with peer comparisons) and patient decision support (reminders and alerts). MEASUREMENTS AND MAIN RESULTS:Process and physiologic outcomes were evaluated in all subjects. Functional status was evaluated in a random patient sample via questionnaire. We used multiple logistic regression to quantify the effect, adjusting for clustering and potential confounders. Intervention subjects were significantly more likely to receive guideline-appropriate testing for cholesterol (OR=1.39; [95%CI 1.07, 1.80] P=0.012), creatinine (OR=1.40; [95%CI 1.06, 1.84] P=0.018), and proteinuria (OR=1.74; [95%CI 1.13, 1.69] P=0.012), but not A1C (OR=1.17; [95% CI 0.80, 1.72] P = 0.43). Rates of control of A1C and LDL cholesterol were similar in the two groups. There were no differences in blood pressure, body mass index, or functional status. CONCLUSIONS:A chronic disease registry and decision support system based on easily obtainable laboratory data was feasible and acceptable to patients and providers. This system improved the process of laboratory monitoring in primary care, but not physiologic control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

et al. 2009

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“…27 Each practice was rated twice by their assigned PF for each of these 9 elementsonce after the initial visit and once at the conclusion of project activities. Each TRANSLATE category was rated on a scale of 1 to 4, with 1 signifying no accomplishment and 4 signifying the highest accomplishment.…”

Section: Practice Readiness For Transformationmentioning

confidence: 99%

A Practice Facilitation and Academic Detailing Intervention Can Improve Cancer Screening Rates in Primary Care Safety Net Clinics

et al. 2016

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Background: Despite the current evidence of preventive screening effectiveness, rates of breast, cervical, and colorectal cancer in the United States fall below national targets. We evaluated the efficacy and feasibility of combining practice facilitation and academic detailing quality improvement (QI) strategies to help primary care practices increase breast, cervical, and colorectal cancer screening among patients.Methods: Practices received a 1-hour academic detailing session addressing current cancer screening guidelines and best practices, followed by 6 months of practice facilitation to implement evidence-based interventions aimed at increasing patient screening. One-way repeated measures analysis of variance compared screening rates before and after the intervention, provider surveys, and TRANSLATE model scores. Qualitative data were gathered via participant focus groups and interviews.Results: Twenty-three practices enrolled in the project: 4 federally qualified health centers, 10 practices affiliated with larger health systems, 4 physician-owned practices, 4 university hospital clinics, and 1 nonprofit clinic. Average screening rates for breast cancer increased by 13% (P ‫؍‬ .001), and rates for colorectal cancer increased by 5.6% (P ‫؍‬ .001). Practices implemented a mix of electronic health record data cleaning workflows, provider audits and feedback, reminder systems streamlining, and patient education and outreach interventions. Practice facilitators assisted practices in tailoring interventions to practice-specific priorities and constraints and in connecting with community resources. Practices with resource constraints benefited from the engagement of all levels of staff in the quality improvement processes and from team-based adaptations to office workflows and policies. Many practices aligned quality improvement interventions in this project with patient-centered medical home and other regulatory reporting targets.Conclusions: Combining practice facilitation and academic detailing is 1 method through which primary care practices can achieve systems-level changes to better manage patient population health. (J Am Board Fam Med 2016;29:533-542.)

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“…Single studies of interventions aimed at both patients and providers have yielded mixed results with respect to improving BP control in patients with diabetes. [29][30][31][32][33][34] However, systematic reviews and meta-analyses have demonstrated decreases in BP associated with group-based or individual patient education and team-based care involving nurses and pharmacists. [35][36][37] Hypertension: Initial Evaluation Patients with diabetes should have their BP measured and recorded at each office visit with an instrument that has been recently calibrated.…”

Section: Effectiveness Of Bp Control: Real-world Practicementioning

confidence: 99%