Comprehensive Evaluation of Community-Based Diabetic Patients
Effect of feedback to patients and their physicians: a randomized controlled trial
- Roland G. Hiss, MD1,
- Mary Lou Gillard, MS1,
- Betty A. Armbruster1 and
- Leslie A. McClure, MS2
- 1Department of Medical Education, University of Michigan Medical School, and the
- 2Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
Abstract
OBJECTIVE—To demonstrate improvements in diabetes care stimulated by comprehensive evaluation of community-based diabetic patients with feedback to the patients and their physicians.
RESEARCH DESIGN AND METHODS—A comprehensive evaluation of community-based diabetic patients with annotated reporting of results to both patients and their physicians (universal intervention) was followed by random assignment of 50% of patients to individual counseling (randomized intervention). In four communities, two large and two small, 55 type 1 and 376 type 2 diabetic patients were recruited, evaluated, and reassessed at 1 year. Outcome measures were HbA1c, serum cholesterol, and systolic and diastolic blood pressure.
RESULTS—There were significant improvements in all outcome measures for type 2 diabetic patients randomized to individual counseling (P = 0.03; follow-up rate 84%) and significant improvements in all outcome measures for all high-risk type 2 patients (highest P value = 0.004; follow-up rate 85%).
CONCLUSIONS—Comprehensive evaluation of diabetic patients at the community level with annotated reporting of results to the patients and their physicians was associated with improvement of mean HbA1c, cholesterol, and systolic and diastolic blood pressure, particularly in patients in high-risk status for these outcome variables. Individual counseling of 50% of patients, randomly selected, enhanced these results.
- DBP, diastolic blood pressure
- MDRTC, Michigan Diabetes Research and Training Center
- SDP, systolic blood pressure
Footnotes
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Address correspondence and reprint requests to Roland G. Hiss, MD, University of Michigan Medical School, Department of Medical Education, G1103 Towsley Center, Box 0201, Ann Arbor, MI 48109-0201. E-mail: redhiss{at}umich.edu.
Received for publication 1 September 2000 and accepted in revised form 21 December 2000.
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