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Journal of General Internal Medicine

, Volume 19, Issue 12, pp 1167–1174 | Cite as

A practical randomized trial to improve diabetes care

  • Russell E. Glasgow
  • Paul A. Nutting
  • Diane K. King
  • Candace C. Nelson
  • Gary Cutter
  • Bridget Gaglio
  • Alanna Kulchak Rahm
  • Holly Whitesides
  • Hilarea Amthauer
Original Articles

Abstract

OBJECTIVE: There is a well-documented gap between diabetes care guidelines and the services received by patients in almost all health care settings. This project reports initial results from a computer-assisted, patient-centered intervention to improve the level of recommended services received by patients from a wide variety of primary care providers.

DESIGN AND SETTINGS: Eight hundred eighty-six patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program. Physicians were stratified and randomized to intervention or control conditions and evaluated on 2 primary outcomes: number of recommended laboratory screenings and recommended patient-centered care activities completed. Secondary outcomes were evaluated using the Problem Areas in Diabetes scale and the Patient Health Questionnaire (PHQ)-9 depression scale, and the RE-AIM framework was used to evaluate potential for dissemination.

RESULTS: The program was well-implemented and significantly improved both number of recommended laboratory assays (3.4 vs 3.1; P<.001) and patient-centered aspects of diabetes care patients received (3.6 vs 3.2; P<.001) compared to those in randomized control practices. Activities that were increased most were foot exams (follow-up rates of 80% vs 52%; P<.003) and nutrition counseling (76% vs 52%; P<.001).

CONCLUSIONS: 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.

Key words

randomized controlled trial health care quality diabetes care computer translation to practice 

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References

  1. 1.
    Grant RW, Hamrick HE, Sullivan CM, et al. Impact of population management with direct physician feedback on care of patients with type 2 diabetes. Diabetes Care. 2003;26:2275–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Glasgow RE, Strycker LA. Level of preventive practices for diabetes management: patient, physician, and office correlates in two primary care samples. Am J Prev Med. 2000;19:9–14.PubMedCrossRefGoogle Scholar
  4. 4.
    Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.Google Scholar
  5. 5.
    Solberg LI, Kottke TE, Brekke ML, et al. Failure of a continuous quality improvement intervention to increase the delivery of preventive services. A randomized trial. Eff Clin Pract. 2000;3:105–15.PubMedGoogle Scholar
  6. 6.
    Nutting P, Rost K, Smith J, Werner JJ, Elliott C. Competing demands from physical problems: effect on initiating and completing depression care over 6 months. Arch Fam Med. 2000;9:1059–64.PubMedCrossRefGoogle Scholar
  7. 7.
    Stange KC, Woolf SH, Gjeltema K. One minute for prevention: the power of leveraging to fulfill the promise of health behavior counseling. Am J Prev Med. 2002;22:320–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Glasgow RE, Goldstein MG, Ockene J, Pronk NP. Translating what we have learned into practice: principles and hypotheses for addressing multiple behaviors in primary care. Am J Prev Med. 2004;27:88–101.PubMedCrossRefGoogle Scholar
  9. 9.
    Glasgow RE. Translating research to practice: lessons learned, areas for improvement, and future directions. Diabetes Care. 2003;26:2451–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Holman H, Lorig K. Patients as partners in managing chronic disease. Partnership is a prerequisite for effective and efficient health care. BMJ. 2000;320:526–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Tunis SR, Stryer DB, Clancey CM. Practical clinical trials. Increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Glasgow RE, Bull SS. Making a difference with interactive technology: considerations in using and evaluating computerized aids for diabetes self-management education. Diabetes Spect. 2001;14:99–106.CrossRefGoogle Scholar
  13. 13.
    Glasgow RE, Bull SS, Piette JD, Steiner J. Interactive behavior change technology: a partial solution to the competing demands of primary care. Am J Prev Med. 2004;27(2 suppl):80–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Street RL Jr, Gold WR, Manning TE. Health Promotion and Interactive Technology: Theoretical Applications and Future Directions. London: Lawrence Erlbaum Associates; 1997.Google Scholar
  15. 15.
    Joyner L, McNeeley S, Kahn R. ADA’s provider recognition program. HMO Pract. 1997;11:168–70.PubMedGoogle Scholar
  16. 16.
    National Committee on Quality Assurance, American Diabetes Association. Diabetes Physician Recognition Program. Available at: http://www.ncqa.org/dprp/dprpmain.htm. Accessed November 23, 2003.Google Scholar
  17. 17.
    Glasgow RE, McKay HG, Piette JD, Reynolds KD. The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management? Patient Educ Couns. 2001;44:119–27.PubMedCrossRefGoogle Scholar
  18. 18.
    Welborn TA, Garcia-Webb P, Bonser A, McCann V, Constable I. Clinical criteria that reflect C-peptide status in idiopathic diabetes. Diabetes Care. 1983;6:315–6.PubMedGoogle Scholar
  19. 19.
    Glasgow RE, Funnell MM, Bonomi AE, Davis C, Beckham V, Wagner EH. Self-management aspects of the improving chronic illness care Breakthrough Series: implementation with diabetes and heart failure teams. Ann Behav Med. 2002;24:80–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Von Korff M, Glasgow RE, Sharpe M. Organizing care for chronic illness. BMJ. 2002;325:92–4.CrossRefGoogle Scholar
  21. 21.
    Glasgow RE, Boles SM, Calder D, Dreyer L, Bagdade J. Diabetes care practices in primary care: results from two samples and three performance indices. Diabetes Educ. 1999;24:755–63.Google Scholar
  22. 22.
    Polonsky WH, Anderson BJ, Lohrer PA, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18:754–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Polonsky W. Emotional and quality-of-life aspects of diabetes management. Curr Diab Rep. 2002;2:153–9.PubMedGoogle Scholar
  24. 24.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.PubMedCrossRefGoogle Scholar
  25. 25.
    Amthauer H, Gaglio B, Glasgow RE, King DK. Strategies and lessons learned in patient recruitment during a diabetes self-management program conducted in a primary care setting. Diabetes Educ. 2003;29:673–81.PubMedGoogle Scholar
  26. 26.
    Glasgow RE, Bull SS, Gillette C, Klesges LM, Dzewaltowski DA. Behavior change intervention research in health care settings: a review of recent reports with emphasis on external validity. Am J Prev Med. 2002;23:62–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Heisler M, Smith DM, Hayward RA, Krein SL, Kerr EA. How well do patients’ assessment of their diabetes self-management correlate with actual glycemic control and receipt of recommended diabetes services? Diabetes Care. 2003;26:738–43.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Russell E. Glasgow
    • 3
  • Paul A. Nutting
    • 1
  • Diane K. King
    • 3
  • Candace C. Nelson
    • 3
  • Gary Cutter
    • 2
  • Bridget Gaglio
    • 3
  • Alanna Kulchak Rahm
    • 3
  • Holly Whitesides
    • 3
  • Hilarea Amthauer
    • 3
  1. 1.Center for Research StrategiesDenver
  2. 2.Cooper InstituteDenver
  3. 3.Kaiser Permanente ColoradoPenrose

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