The Translating Research Into Action for Diabetes (TRIAD) Study
A multicenter study of diabetes in managed care
- The TRIAD Study Group
- HMO, health maintenance organizations
- TRC, translational research center
- TRIAD, Translating Research Into Action for Diabetes.
Diabetes presents formidable challenges to the U.S. health care system because of its high prevalence and morbidity and the complexity and cost of managing the disease (1–2). Diabetes complications can be reduced with efficacious treatments, such as glycemic, blood pressure, lipid control and screening, and early treatment for eye, kidney, and foot disease (3–6); however, these treatments are not adequately implemented (7–11). Thus, there is a need to better understand modifiable factors that affect the quality and outcomes of care across diverse health care systems.
The Translating Research Into Action for Diabetes (TRIAD) study uses Donabedian’s classic paradigm for studying quality of care by relating structural factors in health care systems and provider organization to the processes and outcomes of care (12). Because of the proliferation of managed care systems, with various organizational, reimbursement, and disease management approaches (13–20), managed care is a critical setting in which to apply this paradigm. The TRIAD study is a multicenter prospective study that seeks to identify modifiable barriers to optimal diabetes care across diverse managed care settings. This report describes TRIAD’s study hypotheses, objectives, design, participants, and methods.
The fundamental hypothesis of the TRIAD study is that structural and organizational characteristics of health systems and health care provider groups affect the processes and quality of care that, in turn, influence health and economic outcomes (Fig. 1). More specifically, the TRIAD study hypothesizes that greater experience with managed care, less use of clinician incentives to limit referrals and care, more intense efforts to implement accepted practice guidelines, and the presence of systems to identify, risk stratify, and manage patients (e.g., via registries, reminder systems, and case managers) will be associated with better processes and outcomes of care. Additionally, more direct patient education, fewer financial barriers (e.g., …