Improving Diabetes Care:Effectiveness of Physician Profiling and Care Coordination by a Diabetes Resource Nurse

Not Applicable

Completed

Conditions: Diabetes Mellitus

Interventions: Other: Medicare Claims Feedback
Other: Medical Record Review
Other: Diabetes Resource Nurse

Registration Number: NCT00258674

Lead Sponsor: Baylor Research Institute

Brief Summary: 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.

Detailed Description: 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.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 1891

Inclusion Criteria

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

Exclusion Criteria

Patient chart not available for abstraction

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Medicare Claims Feedback	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.
Medicare Claims+Medical Record Feedback	Medicare Claims 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.
Medicare Claims+Medical Record Feedback	Medical Record Review	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.
Medicare Claims+Medical Chart Review+DRN	Medical Record Review	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.
Medicare Claims+Medical Chart Review+DRN	Medicare Claims Feedback	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.
Medicare Claims+Medical Chart Review+DRN	Diabetes Resource Nurse	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.

Primary Outcome Measures

Name	Time	Method
Change Score for "HbA1c <9 Percent"	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"	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"	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.

Secondary Outcome Measures

Name	Time	Method
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual blood pressure assessment in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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 was calculated by subtracting the follow-up HbA1c value from the baseline value for each patient. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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 was calculated by subtracting the follow-up value from the baseline value for each patient. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual eye exam in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual lipid assessment in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual HbA1c assessment in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual eye exam in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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 was calculated by subtracting the follow-up LDL value from the baseline value for each patient. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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 was calculated by subtracting the follow-up value from the baseline value for each patient. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual lipid assessment in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual foot exam in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual renal function assessment in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual HbA1c assessment in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.
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)	Each patient was assigned a change score of -1, 0, or 1. A positive value indicated a patient who was non-compliant with the guideline recommendation for a semi-annual HbA1c assessment in the baseline period was compliant in the follow-up period. Patients missing either a baseline or follow-up value were excluded. Patient-level change scores were then summed and averaged over each study arm.