Impact of population management with direct physician feedback on care of patients with type 2 diabetes. Export

@article{citeulike:332345, abstract = {OBJECTIVE: Population-level strategies may improve primary care for diabetes. We designed a controlled study to assess the impact of population management versus usual care on metabolic risk factor testing and management in patients with type 2 diabetes. We also identified potential patient-related barriers to effective diabetes management. RESEARCH DESIGN AND METHODS: We used novel clinical software to rank 910 patients in a diabetes registry at a single primary care clinic and thereby identify the 149 patients with the highest HbA(1c) and cholesterol levels. After review of the medical records of these 149 patients, evidence-based guideline recommendations regarding metabolic testing and management were sent via e-mail to each intervention patient's primary care provider (PCP). Over a 3-month follow-up period, we assessed changes in the evidence-based management of intervention patients compared with a matched cohort of control patients receiving usual care at a second primary care clinic affiliated with the same academic medical center. RESULTS: In the intervention cohort, PCPs followed testing recommendations more often (78\%) than therapeutic change recommendations (36\%, P = 0.001). Compared with the usual care control cohort, population management resulted in a greater overall proportion of evidence-based guideline practices being followed (59 vs. 45\%, P = 0.02). Most intervention patients (62\%) had potential barriers to effective care, including depression (35\%), substance abuse (26\%), and prior nonadherence to care plans (18\%). CONCLUSIONS: Population management with clinical recommendations sent to PCPs had a modest but statistically significant impact on the evidence-based management of diabetes compared with usual care. Depression and substance abuse are prevalent patient-level adherence barriers in patients with poor metabolic control.}, address = {General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. rgrant@partners.org}, author = {Grant, R. W. and Hamrick, H. E. and Sullivan, C. M. and Dubey, A. K. and Chueh, H. C. and Cagliero, E. and Meigs, J. B.}, citeulike-article-id = {332345}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/12882848}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=12882848}, issn = {0149-5992}, journal = {Diabetes Care}, keywords = {diabetes, management, rpm, software}, month = {August}, number = {8}, pages = {2275--2280}, posted-at = {2005-09-26 04:28:19}, priority = {2}, title = {Impact of population management with direct physician feedback on care of patients with type 2 diabetes.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/12882848}, volume = {26}, year = {2003} }

TY - JOUR ID - citeulike:332345 L3 - citeulike-article-id:332345 N2 - OBJECTIVE: Population-level strategies may improve primary care for diabetes. We designed a controlled study to assess the impact of population management versus usual care on metabolic risk factor testing and management in patients with type 2 diabetes. We also identified potential patient-related barriers to effective diabetes management. RESEARCH DESIGN AND METHODS: We used novel clinical software to rank 910 patients in a diabetes registry at a single primary care clinic and thereby identify the 149 patients with the highest HbA(1c) and cholesterol levels. After review of the medical records of these 149 patients, evidence-based guideline recommendations regarding metabolic testing and management were sent via e-mail to each intervention patient's primary care provider (PCP). Over a 3-month follow-up period, we assessed changes in the evidence-based management of intervention patients compared with a matched cohort of control patients receiving usual care at a second primary care clinic affiliated with the same academic medical center. RESULTS: In the intervention cohort, PCPs followed testing recommendations more often (78%) than therapeutic change recommendations (36%, P = 0.001). Compared with the usual care control cohort, population management resulted in a greater overall proportion of evidence-based guideline practices being followed (59 vs. 45%, P = 0.02). Most intervention patients (62%) had potential barriers to effective care, including depression (35%), substance abuse (26%), and prior nonadherence to care plans (18%). CONCLUSIONS: Population management with clinical recommendations sent to PCPs had a modest but statistically significant impact on the evidence-based management of diabetes compared with usual care. Depression and substance abuse are prevalent patient-level adherence barriers in patients with poor metabolic control. IS - 8 JF - Diabetes Care SN - 0149-5992 AD - General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. rgrant@partners.org EP - 2280 TI - Impact of population management with direct physician feedback on care of patients with type 2 diabetes. VL - 26 SP - 2275 KW - diabetes KW - management KW - rpm KW - software AU - Grant, RW AU - Hamrick, HE AU - Sullivan, CM AU - Dubey, AK AU - Chueh, HC AU - Cagliero, E AU - Meigs, JB PY - 2003/08// UR - http://view.ncbi.nlm.nih.gov/pubmed/12882848 ER -