Abstract

Objective: Determine whether implementation of a multi-component organizational intervention can produce significant change in diabetes care and outcomes in community primary care practices.

Research Design and Methods: Group-randomized controlled clinical trial evaluating the practical effectiveness of a multi-component intervention (TRANSLATE) in 24 practices. The intervention implemented an electronic diabetes registry, visit reminders, and patient-specific physician alerts. A site coordinator facilitated pre-visit planning and a monthly review of performance with a local physician champion. The principle outcomes were the percent of patients achieving target values for the composite of systolic blood pressure (SBP)<130mmHg, LDL cholesterol<100 mg/dl, and A1c<7.0% at baseline and 12 months. Six process measures were also followed.

Results: Over 24 months, 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practices from 17 health systems. Diabetes process measures increased significantly more in intervention than control practices giving net increases: foot exams 35.0%(p<.0.001); annual eye exams 25.9%(p<0.001); renal testing 28.5% (p<0.001); A1c testing 8.1%(p< 0.001); blood pressure monitoring 3.5% (p=.05) and LDL testing 8.6% (p< 0.001). Mean A1c adjusted for age, gender, and comorbidity decreased significantly in intervention practices (p<.02). At 12 months, intervention practices had significantly greater improvement achieving recommended clinical values for SBP, A1c, and LDL than control clinics (p= 0.002).

Conclusions: Introduction of a multi-component organizational intervention in primary care significantly increases the percentage of type 2 diabetes patients achieving recommended clinical outcomes.