Table 2—

Organizational interventions versus usual care

ReferenceDesignIntervention i) intervention group c) control groupa) Number of providers b) Number of patients c) Number of practicesSettingFollow-up (months) Results
Conclusion
 Patient outcomes  Process measures
Halbert (36) 1999, U.S.RCTi) arrangements for follow up (multiple reminders to patients) c) single reminder directed at patients)a) ? b) 19,523 c) 1 health maintenance organization (HMO); the number of medical groups is not clearpractices affiliated with Network or Independent Practice Association (IPA) HMO12NAmicrov (+)process +
Hawkins (37) 1979 Hawkins (38) 1981; U.S.RCTi) revision of professional roles c) no interventiona) ? (pharmacist, physicians [control group]) b) 315 c) 1hospital-based academic primary care clinic; variable insurance arrangements*29glyc (0)NApatient 0
Jaber (39) 1996, U.S.RCTi) revision of professional roles; patient education c) no interventiona) ? (pharmacist, physicians [control group]) b) 39 c) 1hospital-based academic primary care clinic; variable insurance arrangements4 glyc (+) bp (0)within chol (0)no values reported BMI (0)no values reported microv (0)no values reportedNApatient +
Sadur (40) 1999, U.S.RCTi) clinical multidisciplinary teams; skill mix changes; case management; patient education c) no interventiona) ? (physicians, 1 dietitian, 1 behaviorist, pharmacist, 1 diabetes nurse educator, and 2 diabetologists) b) 185 c) 1capitated group/staff model HMO6 glyc (+)hosp (+)patient + process +
Smith (41) 1986 Smith (42) 1987; the NetherlandsRCTi) arrangements for follow up; patient education; appointment reminders for patients c) no interventiona) ? b) 859 c) 1hospital-based academic primary care clinic; variable insurance arrangements12NAatt pat (+)process +
Branger (33) 1999, U.K.CBAi) changes in medical record systems (electronic communication system between physicians) c) no interventiona) 32 GPs and 1 internal medicine consultant b) 275 c) 1 hospital and ? practicesprimary care physician office; capitation (social)+ fee-for-service (private)12NAglyc (+)# bp (+)# chol (+)# weight (+)# microv (0) att pat (0)process +
Day (34) 1992, U.K.CBAi) revision of professional roles; changes to the setting; a learner-centered counseling approach was adopted allowing patients to identify problems and agree potential solutions c) no interventiona) ? (physicians + diabetes specialist nurse) b) 367 c) 3 clinicsnew purposed-designed diabetes center; fee-for-service36glyc (+)#NApatient +within
De Sonnaville (35) 1997, the NetherlandsCBAi) multidisciplinary team; formal integration of services; arrangements for follow up; communication and case discussion between distant health pro-a) 28 physicians b) 505 c) ?primary care physician office; capitation (social)+ fee-for-service (private)24glyc (+)# bp (0)# chol (+)# BMI (−)#NApatient +
 fessionals; changes to the setting/site of service delivery; changes in medical records systems; patient education c) no intervention
Sullivan (43) 1991, U.K.ITSi) clinical multidisciplinary teams (A joint GP/nurse review system); arrangements of follow-up c) no interventiona) 5 (4 GPs and practice nurse) b) 1983: 53, 1984: 51, 1985: 56, 1986: 61, 1987: 67, 1988: 70 c) 1primary care physician office; capitation and item of service36NAglyc (+/−) bp (+/−) weight (+/−) microv (+/−)process +/−no statistical analyses but a positive trend
  • *

    * In the U.S., most practices, whether hospital-based or not, care for patients under a variety of insurance arrangements: government (Medicare, Medicaid) or private (HMO or indemnity [fee-for-service]). ?, not reported; +, positive effect; 0, no effect; −, negative effect; +/−, effect unclear; NA, not applicable; #, possible unit of analysis error; within, differences are statistically tested within groups only, not between groups; alb, albumin; att pat, attendance patients; bp, blood pressure; comp, compliance care provider; CBA, controlled before-after study; creat, creatinine; glyc, glycemic control; HMO, health maintenance organization; hlth surv, health survey; hosp, hospitalizations; macrov, macrovascular complications; microv, microvascular complications; qual life, quality of life; RCT, randomized controlled trial.