The impact of planned care and a diabetes electronic management system on community-based diabetes care

The mayo health system diabetes translation project

Victor Manuel Montori, Sean F. Dinneen, Colum A. Gorman, Bruce R. Zimmerman, Robert A. Rizza, Susan S. Bjornsen, Erin M. Green, Sandra C. Bryant, Steven A. Smith

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

OBJECTIVE - The Mayo Health System Diabetes Translation Project sought to assess models of community-based diabetes care and use of a diabetes electronic management system (DEMS). Planned care is a redesigned model of chronic disease care that involves guideline implementation, support of self-management, and use of clinical information systems. RESEARCH DESIGN AND METHODS - We studied adult diabetic patients attending three primary care practice sites in Wisconsin and Minnesota. We implemented planned care at all sites and DEMS in the practice of 16 primary care providers. We assessed quality of diabetes care using standard indicators for 200 patients randomly selected from each site at baseline and at 24 months of implementation. We used multivariable analyses to estimate the association between planned care and DEMS and each quality indicator. RESULTS - Planned care was associated with improvements in measurement of HbA 1c (odds ratio 7.0 [95% CI 4.2-11.6]), HDL cholesterol (5.6 [4.1-7.5]), and microalbuminuria (5.3 [3.5-8.0]), as well as the provision of tobacco advice (6.9 [4.7-10.1]), among other performance measures. DEMS use was associated with improvements in all indicators, including microalbuminuria (3.2 [1.9-5.2]), retinal examination (2.4 [1.5-3.9]), foot examinations (2.3 [1.2-4.4]), and self-management support (2.6 [1.7-3.8]). Although planned care was associated with improvements in metabolic control, we observed no additional metabolic benefit when providers used DEMS. CONCLUSIONS - Planned care was associated with improved performance and metabolic outcomes in primary care. DEMS use augmented the impact of planned care on performance outcomes but not on metabolic outcomes. Optimal identification of the best translation of evidence to diabetes practice will require longer follow-up or new care-delivery models.

Original languageEnglish (US)
Pages (from-to)1952-1957
Number of pages6
JournalDiabetes Care
Volume25
Issue number11
DOIs
StatePublished - Nov 2002

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Primary Health Care
Self Care
Health
Quality of Health Care
Standard of Care
Information Systems
HDL Cholesterol
Tobacco
Foot
Chronic Disease
Research Design
Odds Ratio
Guidelines

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

The impact of planned care and a diabetes electronic management system on community-based diabetes care : The mayo health system diabetes translation project. / Montori, Victor Manuel; Dinneen, Sean F.; Gorman, Colum A.; Zimmerman, Bruce R.; Rizza, Robert A.; Bjornsen, Susan S.; Green, Erin M.; Bryant, Sandra C.; Smith, Steven A.

In: Diabetes Care, Vol. 25, No. 11, 11.2002, p. 1952-1957.

Research output: Contribution to journalArticle

Montori, Victor Manuel ; Dinneen, Sean F. ; Gorman, Colum A. ; Zimmerman, Bruce R. ; Rizza, Robert A. ; Bjornsen, Susan S. ; Green, Erin M. ; Bryant, Sandra C. ; Smith, Steven A. / The impact of planned care and a diabetes electronic management system on community-based diabetes care : The mayo health system diabetes translation project. In: Diabetes Care. 2002 ; Vol. 25, No. 11. pp. 1952-1957.
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abstract = "OBJECTIVE - The Mayo Health System Diabetes Translation Project sought to assess models of community-based diabetes care and use of a diabetes electronic management system (DEMS). Planned care is a redesigned model of chronic disease care that involves guideline implementation, support of self-management, and use of clinical information systems. RESEARCH DESIGN AND METHODS - We studied adult diabetic patients attending three primary care practice sites in Wisconsin and Minnesota. We implemented planned care at all sites and DEMS in the practice of 16 primary care providers. We assessed quality of diabetes care using standard indicators for 200 patients randomly selected from each site at baseline and at 24 months of implementation. We used multivariable analyses to estimate the association between planned care and DEMS and each quality indicator. RESULTS - Planned care was associated with improvements in measurement of HbA 1c (odds ratio 7.0 [95{\%} CI 4.2-11.6]), HDL cholesterol (5.6 [4.1-7.5]), and microalbuminuria (5.3 [3.5-8.0]), as well as the provision of tobacco advice (6.9 [4.7-10.1]), among other performance measures. DEMS use was associated with improvements in all indicators, including microalbuminuria (3.2 [1.9-5.2]), retinal examination (2.4 [1.5-3.9]), foot examinations (2.3 [1.2-4.4]), and self-management support (2.6 [1.7-3.8]). Although planned care was associated with improvements in metabolic control, we observed no additional metabolic benefit when providers used DEMS. CONCLUSIONS - Planned care was associated with improved performance and metabolic outcomes in primary care. DEMS use augmented the impact of planned care on performance outcomes but not on metabolic outcomes. Optimal identification of the best translation of evidence to diabetes practice will require longer follow-up or new care-delivery models.",
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