Diabetes Quality Improvement in Department of Veterans Affairs Ambulatory Care Clinics

Abstract

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.

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

“…As reported in several other trials, these care process improvements did not translate into significant effects on biologic or quality-of-life improvements over the time period studied (27)(28)(29). Although the program did not enhance quality of life or reduce depression levels more than the control condition, both conditions showed improvement on these outcomes.…”

Diabetes mellitus en México. El estado de la epidemia

“…Esquemas de incentivos a los proveedores han mostrado efectividad en entornos con indicadores claros y medibles como es el caso de la diabetes, por lo que debe explorarse su uso en lo general para mejorar la atención a padecimientos crónicos. [25][26][27] La comparación entre individuos con diagnóstico previo y el resto de la población muestra, por un lado, la mayor probabilidad de comorbilidades, y por el otro, un perfil de población con mayor riesgo, por ejemplo aquellos con antecedentes familiares. La evidencia científica sobre prevención y tratamiento intensivo para diabetes indica que las acciones en ambas vertientes son costo efectivas y tienen buenos rendimientos cuando las primeras se focalizan en personas con alto riesgo de padecer diabetes y las segundas en el control de la hipertensión, el colesterol y los niveles de glucosa entre las personas que padecen la enfermedad.…”

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