Combined Task Delegation, Computerized Decision Support, and Feedback Improve Cardiovascular Risk for Type 2 Diabetic Patients

Abstract

OBJECTIVE -The Diabetes Care Protocol combines task delegation (a practice nurse), computerized decision support, and feedback every 3 months. We studied the effect of the Diabetes Care Protocol on A1C and cardiovascular risk factors in type 2 diabetic patients in primary care.RESEARCH DESIGN AND METHODS -In a cluster randomized trial, mean changes in cardiovascular risk factors between the intervention and control groups after 1 year were calculated by generalized linear models.RESULTS -Throughout the Netherlands, 26 intervention practices included 1,699 patients and 29 control practices 1,692 patients. The difference in A1C change was not significant, whereas total cholesterol, LDL cholesterol, and blood pressure improved significantly more in the intervention group. The 10-year coronary heart disease risk estimate of the UK Prospective Diabetes Study improved 1.4% more in the intervention group.CONCLUSIONS -Delegation of routine diabetes care to a practice nurse combined with computerized decision support and feedback did not improve A1C but reduced cardiovascular risk in type 2 diabetes patients.

The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

“…Another study in 24 practices in Minnesota, which included a case manager function, showed improvements in both process and outcome 15 . Other interventions have resulted in improvement in process but not laboratory outcomes 8,10,16 . Systematic reviews suggest that quality improvement strategies in diabetes care produce modest results 45,46 .…”

“…The Chronic Care Model highlights the importance of a population-based approach; involving community, patients and providers; and information technology [4][5][6] . Various combinations of population management, practice support, and patient outreach have been used for diabetes care in a variety of settings with mixed results [7][8][9][10][11][12][13][14][15][16] . Many practice interventions for diabetes have been carried out in academic and urban centers.…”

Computerized Decision Support Systems in Primary Care for Type 2 Diabetes Patients Only Improve Patients' Outcomes when Combined with Feedback on Performance and Case Management: A Systematic Review

“…13 The study from Phillips et al 14 and Ziemer et al 6 regarded the same study population, with different outcome measures. This also applies to the three studies of Cleveringa et al [15][16][17] and to the studies from Khan et al 18 and MacLean et al 19 Therefore eventually 20 RCTs were included. Ninety-five articles were excluded because of different reasons, for example, review article (n = 14), no RCT (n = 22), no CDSS used in the intervention (n = 26), glucose monitoring system (n = 10), or diabetes self-management program (n = 11) (Fig.…”

Bruk av skjema i oppfølgingen av diabetes i allmennpraksis

“…I alle studiene hadde legene brukt diabetesskjema, i to av dem i samarbeid med sykepleier (16,17). Tid brukt på opplaering lå på rundt én time der dette ble rapportert.…”

“…Mulighetene for bearbeiding av registrerte pasientdata varierte. Dette kunne vaere funksjoner som automatiske påminnelser til pasienten (18), påminnelser om innkalling til time (13,16,18), forslag om endringer i medisinering (14,18,20) og tilbakemelding om registrerte data for pasienten eller legepraksisen sammenliknet med andre (13,14,19). Inkluderte studier (n = 7)…”