In This Issue: Diabetes Quality of Care

Abstract

Two important and, until recently, undervalued research traditions are brought together in a research study, a case study, and an editorial in this issue. The study by Westfall and colleagues 1 surveys practice-based research networks (PBRNs) and fi nds that more than one half have a method to engage community members and/or patients in their research. In a related case study available online in the Annals, the Community Advisory Council for the High Plains Research Network describes their experience of participating in practice-based network research.2 These articles show the potential for PBRNs to bridge the gap between clinical research and community needs. The editorial by Macauley and Nutting highlights the potential of bringing together PBRN research and community-based participatory research to solve some of the most intractable problems facing health and health care.3 This approach is the kind called for by the NIH Roadmap. 4 Westfall and colleagues and Macauley and Nutting show us the way. If primary care researchers, academic health centers, communities, and primary care practices can come together around a vision for community-and practicebased participatory research, we can reduce the problem of translating research into practice by translating practice and community life into research. DIABETES DIAGNOSIS AND MANAGEMENTThis issue features 5 studies that address diabetes quality of care from innovative viewpoints. These research frameworks are grounded in the perspectives of health care systems, front-line practice, and consideration of how diabetes care is nested within care of other important conditions.In a large study of a cohort of adult patients in a multispecialty medical group, O'Connor and colleagues examine the symptoms, clinical incidents, and types of health care visits that precede the diagnosis of diabetes mellitus.5 They identify markers for the new diagnosis and go further to track the course of important clinical parameters after the diagnosis. The fi ndings are useful in considering how systems and practices might enhance their early recognition and treatment of diabetes. The reduction in risk factors apparent after the diagnosis in this large multispecialty group hints that earlier detection and treatment might be worthwhile.Spann and colleagues 6 provide a snapshot of diabetes care across the United States in a national PBRN. The study fi nds both patient and practice factors that are associated with better process markers of quality care; the authors conclude that substantial practice redesign may be necessary to achieve markedly improved chronic illness care.Three innovatively conceptualized studies in this issue put diabetes care into the context of other competing demands. Fenton and colleagues 7 examine how diabetes process-of-care-quality measures are related both to frequency of visits and to whether visits are for lower-priority conditions based on the Oregon State Prioritized Health Service List. Parchman et al 8 examine how the delivery of recommended diabetes care servic...

Investigation of multimorbidity and prevalent disease combinations in older Irish adults using network analysis and association rules

“…This means that specialist care givers may not be aware of other co-existing conditions when treating individual illnesses and as a result care and communication between the various specialists may be fragmented. The need for integrated care and individualised care plans where one clinician or gerontologist is responsible for coordinating the care of each individual morbidity has been well documented 54–56 and the complex interrelationship between morbidities in ageing Irish adults shown in this work supports this evidence.…”