Diabetes Care Organization, Process, and Patient Outcomes: Effects of a Diabetes Control Program

Carlson, Anita; Rosenqvist, Urban

doi:10.1177/014572179101700109

Cited by 37 publications

(13 citation statements)

References 15 publications

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“…In 14 (20,21,23,28,29,31,39,44,(51)(52)(53)58,59,64) of these, the guidelines were locally developed, in 11 studies (22,24,26,27,32,35,36,47,55,57,60) they were based on national guidelines, and in 2 studies (46,54) the source of the guidelines was not specified.…”

Section: Discussionmentioning

confidence: 99%

“…In 18 studies (21,(27)(28)(29)33,34,36,37,40,41,47,51,52,56,60,61,63,66), the outcomes were all reliably assessed (outcomes obtained from an automated system or a reported agreement between two raters Ͼ90% or Ն 0.8). Furthermore, 15 studies (20,22,26,32,35,39,44,46,50,53,54,57,59,62,64) included objective laboratory assessment of glycemic control.…”

Section: Study Qualitymentioning

confidence: 99%

“…In four of these studies (22,23,27,29), the professional intervention was combined with patient education. Postgraduate education of health care professionals combined with local consensus procedures and/or reminders and/or audit and feedback improved the provision of diabetes care in all studies (20,21,23,24,26,27,31,32) that did not demonstrate a good standard of care at baseline. The effect on patient outcomes was less clear because such outcomes were rarely assessed.…”

Section: Professional Interventions Versus Usual Carementioning

confidence: 99%

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Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

et al. 2001

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OBJECTIVE -To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings. RESEARCH DESIGN AND METHODS-A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used.RESULTS -A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care.CONCLUSIONS -Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care. Diabetes Care 24:1821-1833, 2001D iabetes is a major and growing health care problem. Primarily because of the increasing prevalence of type 2 diabetes as well as the increase in cases of type 1 diabetes (1), it is expected that the number of people with diabetes will double by the year 2010 (2).Diabetes accounts for a huge burden of morbidity and mortality through micro-and macrovascular complications (3,4). However, it is now clear that strict control of blood glucose, blood pressure, and cholesterol can reduce the risk of diabetes-related complications (5-8). To achieve strict control, structured care is needed (9).Over the past 20 years, the responsibility for the care of people with diabetes has shifted away from hospitals to primary care (10,11). During this period, randomized trials have demonstrated that if regular review of patients is guaranteed, the standard of primary care can be as good or better than hospital outpatient care in the short term (9). Several guidelines and diabetes management programs have been developed nationally and locally to improve diabetes care in the community. However, empirical data suggest that compliance with diabetes clinical practice recommendations is inadequate in primary care (12)(13)(14...

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Section: Discussionmentioning

confidence: 99%

Section: Study Qualitymentioning

confidence: 99%

Section: Professional Interventions Versus Usual Carementioning

confidence: 99%

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Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

et al. 2001

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“…These content areas are presented in behavioral terms and thereby exemplify the importance of action-oriented, behavioral goals and objectives (13,21,55,121–123,128,129). Creative, patient-centered experience-based delivery methods are effective for supporting informed decision-making and behavior change and go beyond the acquisition of knowledge.…”

Section: Standardsmentioning

confidence: 99%

National Standards for Diabetes Self-Management Education

Funnell

Brown

Childs³

et al. 2011

Diabetes Care

278

289

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“…Several randomized clinical trials evaluated the effectiveness of professional interventions focusing on providers in intervention practices compared with usual care (5)(6)(7)(8)(9)(10). These trials identified improvements in diabetes process measures but did not directly assess outcomes.…”

mentioning

confidence: 99%

Diabetes Quality Improvement in Department of Veterans Affairs Ambulatory Care Clinics

Reiber

McDonell

et al. 2004

Diabetes Care

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OBJECTIVE— To conduct a group-randomized clinical trial to determine whether regular feedback to primary care providers of synthesized information on patients’ health, function, and satisfaction would demonstrate improved outcomes for their patients with diabetes. RESEARCH DESIGN AND METHODS—Patients in General Internal Medicine Clinics Department of Veterans Affairs (VA) Medical Centers were randomized into seven intervention or control firms. Patient self-reported information was collected by mail on general health, diabetes, and up to five other chronic conditions. Patients with diabetes received the Seattle Diabetes Questionnaire, the 36-item Medical Outcomes Study short form (SF-36), and a validated patient satisfaction questionnaire at regular intervals. Data from self-report, clinical, pharmacy, and laboratory sources were synthesized into patient-specific feedback reports that intervention providers received before patients’ visits. RESULTS—The timely delivery to primary care providers of state-of-the-art patient-feedback reports that identified patient issues and areas for improvement did not result in significant improvements in patient outcomes between the intervention and control firms. CONCLUSIONS—Outcomes in diabetic patients whose providers received synthesized patient data before visits were no better than in those receiving care from control firms. Future studies may benefit from substantial involvement in patients discussing, problem solving, and goal setting in addition to use of timely synthesized patient data.

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Diabetes Care Organization, Process, and Patient Outcomes: Effects of a Diabetes Control Program

Cited by 37 publications

References 15 publications

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community Settings

National Standards for Diabetes Self-Management Education

Diabetes Quality Improvement in Department of Veterans Affairs Ambulatory Care Clinics

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