An endocrinologist-supported intervention aimed at providers improves diabetes management in a primary care site: Improving primary care of African Americans with diabetes (IPCAAD) 7

Lawrence S. Phillips, David C. Ziemer, Joyce P. Doyle, Catherine S. Barnes, Paul Kolm, William T. Branch, Jane M. Caudle, Curtiss B. Cook, Virginia G. Dunbar, Imad M. El-Kebbi, Daniel L. Gallina, Risa P. Hayes, Christopher D. Miller, Mary K. Rhee, Dennis M. Thompson, Clyde Watkins

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

OBJECTIVE - Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS - A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both. RESULTS - Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA1c (AlC) with feedback + reminders (ΔAlC 0.6%, final AlC 7.46%) were significantly better than control (ΔAlC 0.2%, final AlC 7.84%, P < 0.02); changes were smaller with feedback only and reminders only (P = NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both AlC and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final AlC 7.5 vs. 8.2%, P < 0.001). CONCLUSIONS - Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalises with diabetes specialists may be important to enhance diabetes management in other primary care settings.

Original languageEnglish (US)
Pages (from-to)2352-2360
Number of pages9
JournalDiabetes Care
Volume28
Issue number10
DOIs
StatePublished - Oct 2005

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African Americans
Primary Health Care
Blood Pressure
Internal Medicine
Municipal Hospitals
Time Management
LDL Cholesterol
Type 2 Diabetes Mellitus
Research Design
Endocrinologists
Glucose
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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An endocrinologist-supported intervention aimed at providers improves diabetes management in a primary care site : Improving primary care of African Americans with diabetes (IPCAAD) 7. / Phillips, Lawrence S.; Ziemer, David C.; Doyle, Joyce P.; Barnes, Catherine S.; Kolm, Paul; Branch, William T.; Caudle, Jane M.; Cook, Curtiss B.; Dunbar, Virginia G.; El-Kebbi, Imad M.; Gallina, Daniel L.; Hayes, Risa P.; Miller, Christopher D.; Rhee, Mary K.; Thompson, Dennis M.; Watkins, Clyde.

In: Diabetes Care, Vol. 28, No. 10, 10.2005, p. 2352-2360.

Research output: Contribution to journalArticle

Phillips, LS, Ziemer, DC, Doyle, JP, Barnes, CS, Kolm, P, Branch, WT, Caudle, JM, Cook, CB, Dunbar, VG, El-Kebbi, IM, Gallina, DL, Hayes, RP, Miller, CD, Rhee, MK, Thompson, DM & Watkins, C 2005, 'An endocrinologist-supported intervention aimed at providers improves diabetes management in a primary care site: Improving primary care of African Americans with diabetes (IPCAAD) 7', Diabetes Care, vol. 28, no. 10, pp. 2352-2360. https://doi.org/10.2337/diacare.28.10.2352
Phillips, Lawrence S. ; Ziemer, David C. ; Doyle, Joyce P. ; Barnes, Catherine S. ; Kolm, Paul ; Branch, William T. ; Caudle, Jane M. ; Cook, Curtiss B. ; Dunbar, Virginia G. ; El-Kebbi, Imad M. ; Gallina, Daniel L. ; Hayes, Risa P. ; Miller, Christopher D. ; Rhee, Mary K. ; Thompson, Dennis M. ; Watkins, Clyde. / An endocrinologist-supported intervention aimed at providers improves diabetes management in a primary care site : Improving primary care of African Americans with diabetes (IPCAAD) 7. In: Diabetes Care. 2005 ; Vol. 28, No. 10. pp. 2352-2360.
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abstract = "OBJECTIVE - Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS - A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both. RESULTS - Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA1c (AlC) with feedback + reminders (ΔAlC 0.6{\%}, final AlC 7.46{\%}) were significantly better than control (ΔAlC 0.2{\%}, final AlC 7.84{\%}, P < 0.02); changes were smaller with feedback only and reminders only (P = NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both AlC and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final AlC 7.5 vs. 8.2{\%}, P < 0.001). CONCLUSIONS - Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalises with diabetes specialists may be important to enhance diabetes management in other primary care settings.",
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AU - Doyle, Joyce P.

AU - Barnes, Catherine S.

AU - Kolm, Paul

AU - Branch, William T.

AU - Caudle, Jane M.

AU - Cook, Curtiss B.

AU - Dunbar, Virginia G.

AU - El-Kebbi, Imad M.

AU - Gallina, Daniel L.

AU - Hayes, Risa P.

AU - Miller, Christopher D.

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AU - Thompson, Dennis M.

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N2 - OBJECTIVE - Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS - A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center. We studied all patients (4,138) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were randomized to be control subjects or to receive one of three interventions. Instead of consultative advice, the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient's visit, individual face-to-face feedback on performance for 5 min every 2 weeks, or both. RESULTS - Over an average patient follow-up of 15 months within the intervention site, improvements in and final HbA1c (AlC) with feedback + reminders (ΔAlC 0.6%, final AlC 7.46%) were significantly better than control (ΔAlC 0.2%, final AlC 7.84%, P < 0.02); changes were smaller with feedback only and reminders only (P = NS vs. control). Trends were similar but not significant with systolic blood pressure (sBP) and LDL cholesterol. Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both AlC and sBP. Over a 2-year period, overall glycemic control improved in the intervention site but did not change in other primary care sites (final AlC 7.5 vs. 8.2%, P < 0.001). CONCLUSIONS - Feedback on performance aimed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control. Partnering generalises with diabetes specialists may be important to enhance diabetes management in other primary care settings.

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