A Randomized Trial of Strategies to Improve Diabetes Care: Effectiveness and Costs of Physician Profiling and Care Coordination by a Diabetes Resource Nurse
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,891
- 试验地点
- 1
- 主要终点
- Change Score for "HbA1c <9 Percent"
研究概览
简要总结
The purpose of this study is to test the effectiveness of physician profiling and care coordination by a diabetes resource nurse in improving the quality of diabetes care.
详细描述
HealthTexas Provider Network primary care practices with at least 10 Medicare diabetes patients over the age of 65 were randomized to one of 3 intervention arms: physician feedback of process measures using Medicare claims data ("Claims"); feedback of Medicare claims data plus clinical measures from medical record abstraction ("Claims+MR"); or both types of feedback plus a practice-based DRN ("DRN"). For the 12 months prior to the intervention and 12 months post-intervention, performance data on diabetes related processes of care (annual HbA1c testing, annual LDL cholesterol screening, annual hypertension screening, annual eye, foot, and renal assessment) and patient outcomes (HbA1c level, LDL cholesterol level, blood pressure) were collected from medical record abstraction and Medicare claims data. Pre-post change scores will be compared between intervention arms to examine effectiveness of physician profiling and care coordination by a diabetes resource nurse.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •age ≥ 65 years on January 1, 2000
- •diagnosis of diabetes mellitus
- •diabetes related visit to HTPN physician within the past year
- •Resident of Texas
- •Medicare insurance coverage
排除标准
- •Patient chart not available for abstraction
研究组 & 干预措施
Medicare Claims Feedback
Practices randomised to the Medicare Claims Feedback arm received period feedback on their performance on selected diabetes quality of care measures as reflected in the claims data for their diabetes patients.
干预措施: Medicare Claims Feedback (Other)
Medicare Claims+Medical Record Feedback
Practices randomised to the Medicare Claims + Medical Record Review Feedback arm received periodic feedback on their performance on selected diabetes quality of care measures as reflected in both the Medicare claims for the diabetes patients AND review/audit of their diabetes patients' medical records.
干预措施: Medicare Claims Feedback (Other)
Medicare Claims+Medical Record Feedback
Practices randomised to the Medicare Claims + Medical Record Review Feedback arm received periodic feedback on their performance on selected diabetes quality of care measures as reflected in both the Medicare claims for the diabetes patients AND review/audit of their diabetes patients' medical records.
干预措施: Medical Record Review (Other)
Medicare Claims+Medical Chart Review+DRN
In addition to the performance data from both Medicare Claims data and from review of patients' medical records, practices randomised to the Medicare Claims + Medical Record review + Diabetes Resource Nurse (DRN) had a diabetes resource nurse assigned to them, who was available to provide diabetes education and care-coordination type services for their diabetes patients.
干预措施: Medicare Claims Feedback (Other)
Medicare Claims+Medical Chart Review+DRN
In addition to the performance data from both Medicare Claims data and from review of patients' medical records, practices randomised to the Medicare Claims + Medical Record review + Diabetes Resource Nurse (DRN) had a diabetes resource nurse assigned to them, who was available to provide diabetes education and care-coordination type services for their diabetes patients.
干预措施: Medical Record Review (Other)
Medicare Claims+Medical Chart Review+DRN
In addition to the performance data from both Medicare Claims data and from review of patients' medical records, practices randomised to the Medicare Claims + Medical Record review + Diabetes Resource Nurse (DRN) had a diabetes resource nurse assigned to them, who was available to provide diabetes education and care-coordination type services for their diabetes patients.
干预措施: Diabetes Resource Nurse (Other)
结局指标
主要结局
Change Score for "HbA1c <9 Percent"
时间窗: This measure compared baseline values (01/01/2000-12/31/2000) to follow-up values (01/01/2001-12/31/2001)
Each patient was assigned a "change score" of -1, 0, or 1. A positive value indicated a patient non-adherent to the guideline recommendation for HbA1c \<9 percent at baseline had achieved such a level at follow up. Patient-level change scores were then summed and averaged over each study arm.
Change Score for "Blood Pressure (b.p.) <130/80 mmHg"
时间窗: change from baseline (01/01/2000-12/31/2000) to follow-up (01/01/200112/31/2001)
Each patient was assigned a change score of -1, 0, or 1. A positive value indicated that a patient non-adherent to the guideline recommendation of blood pressure \<130/80 mmHg at baseline had achieved adherence at follow-up. Patient-level change scores were then summed and averaged over each study arm.
Change Score for "LDL <100 mg/dL"
时间窗: change from baseline (01/01/2000-12/31/2000) to follow-up (01/01/2001-12/31/2001)
Each patient was assigned a "change score" of -1, 0, or 1. A positive value indicated that a patient non-adherent to the guideline recommendation of LDL \<100 mg/dL at baseline had achieved adherence at follow-up. Patient-level change scores were then summed and averaged over each study arm.
次要结局
- Change Score for "Annual Blood Pressure Assessment" (as Determined From Medical Record Review)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "HbA1c Level"(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Diastolic Blood Pressure"(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Annual Eye Exam" (as Determined From Medical Record Review)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Annual Lipid Assessment" (as Determined From Medicare Claims Data)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Annual HbA1c Assessment" (as Determined From Medical Record Review)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Annual Eye Exam" (as Determined From Medicare Claims Data)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "LDL Level"(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Systolic Blood Pressure"(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Annual Lipid Assessment" (as Determined From Medical Record Review)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Annual Foot Exam" (as Determined by Medical Record Review)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Annual Renal Function Assessment" (as Determined From Medical Record Review)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Annual HbA1c Assessment" (as Determined From Medicare Claims Data)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))
- Change Score for "Semiannual HbA1c Assessment" (as Determined From Medicare Claims Data)(change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001))