Impact of Automated Calls With Nurse Follow-Up on Diabetes Treatment Outcomes in a Department of Veterans Affairs Health Care System

A randomized controlled trial

  1. John D. Piette, PHD,
  2. Morris Weinberger, PHD,
  3. Frederic B. Kraemer, MD and
  4. Stephen J. McPhee, MD
  1. From the Center for Health Care Evaluation/HSR&D Center of Excellence (J.D.P., F.B.K.), VA Palo Alto Health Care System, Palo Alto; the School of Medicine (F.B.K.) and Department of Health Research and Policy, Center for Primary Care and Outcomes Research (J.D.P.), Stanford University, Stanford; the Department of Medicine (S.J.M.), University of California, San Francisco, California; and the Roudenbush VA Medical Center (M.W.), Indiana University School of Medicine, Regenstrief Institute for Health Care, Indianapolis, Indiana.
  1. Address correspondence and reprint requests to John D. Piette, PhD, Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park Division (152), 795 Willow Rd., Menlo Park, CA 94025. E-mail: jpiette{at} .


OBJECTIVE— We evaluated automated telephone disease management (ATDM) with telephone nurse follow-up as a strategy for improving diabetes treatment processes and outcomes in Department of Veterans Affairs (VA) clinics. We also compared the results with those of a prior ATDM trial conducted in a county health care system.

RESEARCH DESIGN AND METHODS— A total of 272 VA patients with diabetes using hypoglycemic medications were randomized. During the 1-year study period, intervention patients received biweekly ATDM health assessment and self-care education calls, and a nurse educator followed up with patients based on their ATDM assessment reports. Telephone surveys were used to measure patients' self-care, symptoms, and satisfaction with care. Outpatient service use was evaluated using electronic databases and self-reports, and glycemic control was measured by HbAlc and serum glucose testing.

RESULTS— At 12 months, intervention patients reported more frequent glucose self-monitoring and foot inspections than patients receiving usual care and were more likely to be seen in podiatry and diabetes specialty clinics. Intervention patients also were more likely than control patients to have had a cholesterol test. Among patients with baseline HbAlc levels ≥8%, mean end-point values were lower among intervention patients than control patients (8.7 vs. 9.2%, respectively; P = 0.04). Among intervention and control patients with baseline values ≥9%, mean end-point values were 9.1 and 10.2%, respectively (P = 0.04). At follow-up, intervention patients reported fewer symptoms of poor glycemic control than control patients and greater satisfaction with their health care.

CONCLUSIONS— This intervention improved the quality of VA diabetes care. Intervention effects for most end points replicated findings from the prior county clinic trial, although intervention—control differences in the current study were smaller because of the relatively good self-care and health status among the current study's enrollees.


  • Abbreviations: ATDM, automated telephone disease management; VA, Veterans Affairs; SMBG, self-monitored blood glucose.

  • The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted October 20, 2000.
    • Received April 27, 2000.
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