The Impact of Planned Care and a Diabetes Electronic Management System on Community-Based Diabetes Care

The Mayo Health System Diabetes Translation Project

  1. Victor M. Montori, MD, MSC1,
  2. Sean F. Dinneen, MD2,
  3. Colum A. Gorman, MD13,
  4. Bruce R. Zimmerman, MD1,
  5. Robert A. Rizza, MD1,
  6. Susan S. Bjornsen, RD, CDE1,
  7. Erin M. Green4,
  8. Sandra C. Bryant, MS4,
  9. Steven A. Smith, MD13 and
  10. for The Translation Project Investigator Group
  1. 1Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota
  2. 2Addenbrookes Hospital, Cambridge, U.K
  3. 3Division of Health Care Policy and Research and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
  4. 4Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota

    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 HbA1c (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.

    Footnotes

    • Address correspondence and reprint requests to Steven A. Smith, MD, Mayo W18A, 200 First St., SW, Rochester, MN 55905. E-mail: smith.steven{at}mayo.edu.

      Received for publication 22 March 2002 and accepted in revised form 29 July 2002.

      C.A.G. has received grant support from Novo Nordisk. R.A.R. has received grant support and consulting fees from Novo Nordisk. S.S.B. has received grant support from Novo Nordisk and the Mayo Foundation. S.A.S. has received grant support from Novo Nordisk, the American Diabetes Association, and the Mayo Foundation.

    • †Deceased.

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

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