Improving diabetes care in practice

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

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

OBJECTIVE- The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practices. RESEARCH DESIGN AND METHODS- This was a group-randomized, controlled clinical trial evaluating the practical effectiveness of a multicomponent intervention (TRANSLATE) in 24 practices. The intervention included implementation of an electronic diabetes registry, visit reminders, and patient-specific physician alerts. A site coordinator facilitated previsit planning and a monthly review of performance with a local physician champion. The principle outcomes were the percentage of patients achieving target values for the composite of systolic blood pressure (SBP) < 130 mmHg, LDL cholesterol <100 mg/dl, and A1C <7.0% at baseline and 12 months. Six process measures were also followed. RESULTS- Over 24 months, 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practices from 17 health systems. Diabetes process measures increased significantly more in intervention than in control practices, giving net increases as follows: foot examinations 35.0% (P < 0.0.001); annual eye examinations 25.9% (P < 0.001); renal testing 28.5% (P < 0.001); A1C testing 8.1%(P < 0.001); blood pressure monitoring 3.5% (P = 0.05); and LDL testing 8.6% (P < 0.001). Mean A1C adjusted forage, sex, and comorbidity decreased significantly in intervention practices (P < 0.02). At 12 months, intervention practices had significantly greater improvement in achieving recommended clinical values for SBP, A1C, and LDL than control clinics (P = 0.002). CONCLUSIONS- Introduction of a multicomponent organizational intervention in the primary care setting significantly increases the percentage of type 2 diabetic patients achieving recommended clinical outcomes.

Original languageEnglish (US)
Pages (from-to)2238-2243
Number of pages6
JournalDiabetes Care
Volume31
Issue number12
DOIs
StatePublished - 2008

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Blood Pressure
Process Assessment (Health Care)
Primary Health Care
Physicians
Health Personnel
LDL Cholesterol
Type 2 Diabetes Mellitus
Registries
Comorbidity
Foot
Research Design
Randomized Controlled Trials
Kidney
Health
oxidized low density lipoprotein

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Peterson, K. A., Radosevich, D. M., O'Connor, P., Nyman, J. A., Prineas, R. J., Smith, S. A., ... Hannan Mstat, P. J. (2008). Improving diabetes care in practice. Diabetes Care, 31(12), 2238-2243. https://doi.org/10.2337/dc08-2034

Improving diabetes care in practice. / Peterson, Kevin A.; Radosevich, David M.; O'Connor, Patrickj; Nyman, John A.; Prineas, Ronald J.; Smith, Steven A.; Arneson, Thomas J.; Corbett, Victor A.; Weinhandl, Joyce C.; Lange Rd, Carol J.; Hannan Mstat, Peter J.

In: Diabetes Care, Vol. 31, No. 12, 2008, p. 2238-2243.

Research output: Contribution to journalArticle

Peterson, KA, Radosevich, DM, O'Connor, P, Nyman, JA, Prineas, RJ, Smith, SA, Arneson, TJ, Corbett, VA, Weinhandl, JC, Lange Rd, CJ & Hannan Mstat, PJ 2008, 'Improving diabetes care in practice', Diabetes Care, vol. 31, no. 12, pp. 2238-2243. https://doi.org/10.2337/dc08-2034
Peterson KA, Radosevich DM, O'Connor P, Nyman JA, Prineas RJ, Smith SA et al. Improving diabetes care in practice. Diabetes Care. 2008;31(12):2238-2243. https://doi.org/10.2337/dc08-2034
Peterson, Kevin A. ; Radosevich, David M. ; O'Connor, Patrickj ; Nyman, John A. ; Prineas, Ronald J. ; Smith, Steven A. ; Arneson, Thomas J. ; Corbett, Victor A. ; Weinhandl, Joyce C. ; Lange Rd, Carol J. ; Hannan Mstat, Peter J. / Improving diabetes care in practice. In: Diabetes Care. 2008 ; Vol. 31, No. 12. pp. 2238-2243.
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