Randomized Effectiveness Trial of a Computer-Assisted Intervention to Improve Diabetes Care

  1. Russell E. Glasgow, PHD1,
  2. Paul A. Nutting, MD, MSPH2,
  3. Diane K. King, MS, OTR1,
  4. Candace C. Nelson, MA1,
  5. Gary Cutter, PHD3,
  6. Bridget Gaglio, MPH1,
  7. Alanna Kulchak Rahm, MS1 and
  8. Holly Whitesides, BS1
  1. 1Kaiser Permanente Colorado, Denver, Colorado
  2. 2Department of Family Medicine University of Colorado Health Sciences Center, Center for Research Strategies, Denver, Colorado
  3. 3Cooper Institute, Denver, Colorado
  1. Address correspondence and reprint requests to Russell E. Glasgow, PhD, Kaiser Permanente Colorado, 335 Road Runner Ln., Penrose, CO 81240. E-mail: russg{at}ris.net

Abstract

OBJECTIVE—There is a well-documented gap between diabetes care guidelines and the services received by patients in most health care settings. This report presents 12-month follow-up results from a computer-assisted, patient-centered intervention to improve the level of recommended services patients received from a variety of primary care settings.

RESEARCH DESIGN AND METHODS—A total of 886 patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program. Physicians were stratified and randomized to intervention or control conditions and evaluated on two primary outcomes: number of recommended laboratory screenings and recommended patient-centered care activities completed from the National Committee on Quality Assurance/American Diabetes Association Provider Recognition Program (PRP). Secondary outcomes were evaluated using the Problem Areas in Diabetes 2 quality of life scale, lipid and HbA1c levels, and the Patient Health Questionnaire-9 depression scale.

RESULTS—The program was well implemented and significantly improved both the number of laboratory assays and patient-centered aspects of diabetes care patients received compared with those in the control condition. There was overall improvement on secondary outcomes of lipids, HbA1c, quality of life, and depression scores; between-condition differences were not significant.

CONCLUSIONS—Staff in small, mixed-payer primary care offices can consistently implement a patient-centered intervention to improve PRP measures of quality of diabetes care. Alternative explanations for why these process improvements did not lead to improved outcomes, and suggested directions for future research are discussed.

Footnotes

    • Accepted September 22, 2004.
    • Received July 14, 2004.
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