Performance of Primary Care Physicians and Other Providers on Key Process Measures in the Treatment of Diabetes

Morrison, Fritha; Shubina, Maria; Goldberg, Saveli; Turchin, Alexander

doi:10.2337/dc12-1382

Cited by 27 publications

(28 citation statements)

References 43 publications

(41 reference statements)

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“…The intervention was developed to allow real‐time, individualized risk communication in routine primary care consultation. Recent studies have shown that primary care is the key point of contact with the healthcare system for people with T2DM and that general practitioners (GP) play a crucial role in the management of T2DM, making such consultations a logical focus for promoting lifestyle change in this population.…”

Section: Methodsmentioning

confidence: 99%

Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Rouyard

Leal

Baskerville

et al. 2018

Endocrino Diabet & Metabol

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SummaryObjectives: To assess the feasibility in routine primary care consultation and investigate the effect on risk recall and self-management of a new type of risk communication intervention based on behavioural economics ("nudge-based") for people with Type 2 diabetes mellitus (T2DM).Methods: Forty adults with poorly controlled T2DM (HbA1c > 7.5%) were randomized to receive a personalized, nudge-based risk communication intervention (n = 20) or standard care (n = 20). Risk recall and self-management were evaluated at baseline and 12 weeks after the intervention.Results: Both in terms of feasibility and acceptability, this new risk communication intervention was very satisfactory. Study retention rate after 12 weeks was very high (90%) and participants were highly satisfied with the intervention (4.4 out of 5 on the COMRADE scale). Although not powered to identify significant between-group effects, the intervention significantly improved risk recall after 12 weeks and intentions to make lifestyle changes (dietary behaviour) compared to standard care. Conclusions:This pilot study provides the first evidence of the feasibility of implementing in primary care a nudge-based risk communication intervention for people with T2DM. Based on the promising results observed, an adequately powered trial to determine the effectiveness of the intervention on long-term self-management is judged feasible. As a result of this feasibility study, some minor adaptations to the intervention and study methods that would help to facilitate a definitive trial are also reported. K E Y W O R D Sbehavioural economics, pilot randomized trial, primary care, risk communication, selfmanagement, Type 2 diabetes

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Section: Methodsmentioning

confidence: 99%

Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Rouyard

Leal

Baskerville

et al. 2018

Endocrino Diabet & Metabol

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“…Physicians provide patients with clear explanations and expectations to cope with their illness. Consequently, care providers will improve longterm ability to preserve an effective disease management [11]. The second dashboard, in this case study, that monitor assignment progress helps us understand the spots in terms of usage and interaction, which has an impact on assignments progression.…”

Section: Discussionmentioning

confidence: 99%

Digital Transformation in the Area of Diabetes Management through Business Intelligence Technology

Daghistani¹,

Ghamdi²,

Ghamdi³

et al. 2020

IJCA

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Digital transformation and business intelligence in healthcare services for solving analytical tasks is a must. Analytic solutions continue to grow and will play an ever-increasing role in the healthcare future.Accordingly, healthcare organizations in quest of effective IT artifacts that will support the provision of a high quality care for patient based on accurate data analytics-based insights. In the area of diabetes management, there is a need for tools to track key indicators to support decision-making and provide elevated care. They require business intelligence for dashboards to visualize digitized data in order to gain insights regarding diabetes patient care and management. Simple and effective dashboards is mostly technology oriented to help physicians leverage patients' data most effectively.

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“…[3,9] Gaps in compliance with these types of patient-centered quality measures were recently reported by researchers who analysed the medical records of 27,225 patients with diabetes and 584,587 encounters with their primary care providers. [10] Only 40% of the patients' records indicated that providers offered lifestyle counseling, and only 10% documented medication intensification, which reflects a lack of communication and shared decision-making about appropriate therapy changes. Moreover, among 80% of the patients, values for A1C, LDL cholesterol, or blood pressure were at suboptimal levels.…”

Section: Problemmentioning

confidence: 99%

“…Moreover, among 80% of the patients, values for A1C, LDL cholesterol, or blood pressure were at suboptimal levels. [10] Deficiencies in patient-centered care predict low levels of patient activation and engagement, negligent self-management practices, nonadherence to medications, and poor glycemic control. [9] Studies have shown that lower levels of satisfaction with diabetes treatments are associated with nonadherence to medications and monitoring regimens, as well as with negative outcomes including poor A1C control.…”

Section: Problemmentioning

confidence: 99%

Applying quality improvement into systems-based learning to improve diabetes outcomes in primary care

Moreo¹,

Sapir²,

Greene³

2015

BMJ Qual Improv Report

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In the U.S., where the prevalence of type 2 diabetes has reached epidemic proportions, many patients with this disease are treated by primary care physicians in community-based systems, including accountable care organisations (ACOs). To address gaps in the quality of diabetes care, national quality measures have been established, including patient-centered measures adopted by the Centers for Medicare and Medicaid Services for its Shared Savings Program for ACOs.From a patient-centered perspective, high-quality diabetes care depends on effective communication between clinicians and patients, along with patient education and counseling about medications and lifestyle. We designed and implemented a quality improvement (QI) program for 30 primary care physicians treating patients with type 2 diabetes in three structurally similar but geographically diverse ACOs. Retrospective chart audits were conducted before (n = 300) and after (n = 300) each physician participated in accredited continuing medical education (CME) courses that focused on QI strategies. Randomly selected charts were audited to measurably assess essential interventions for improved outcomes in type 2 diabetes including the physicians’ documentation of patient counseling and assessment of side effects, and patients’ medication adherence status and changes in hemoglobin A1C (A1C) and body mass index (BMI). Paced educational interventions included a private performance improvement Internet live course conducted for each physician, small-group Internet live courses involving peer discussion, and a set of enduring materials, which were also multi-accredited for all clinicians in the physician's practice. Continual improvement cycles were guided by analysis of the baseline chart audits, quantitative survey data, and qualitative feedback offered by participants. To extend the benefit of the education, the enduring materials were offered to the interprofessional team of clinicians throughout the U.S. who did not participate in the QI program. For brevity, this article presents outcomes of the 30 primary care physicians.Baseline to post-education improvements were observed for percentages of charts with documented assessment of medication side effects (+11%) and counseling about medication risks/benefits (+28%), medication adherence (+13%), and lifestyle modifications (+8%). Improvements were also observed for documented adherence to diabetes medications (+24%) and first-to-last visit changes in A1C (−0.16%) and BMI (−2.1). The findings indicate a positive influence of QI education on primary care physicians’ performance of patient-centered quality measures and patient outcomes.

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Performance of Primary Care Physicians and Other Providers on Key Process Measures in the Treatment of Diabetes

Cited by 27 publications

References 43 publications

Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Digital Transformation in the Area of Diabetes Management through Business Intelligence Technology

Applying quality improvement into systems-based learning to improve diabetes outcomes in primary care

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