The Impact of Planned Care and a Diabetes Electronic Management System on Community-Based Diabetes Care

Author:

Montori Victor M.1,Dinneen Sean F.2,Gorman Colum A.13,Zimmerman Bruce R.1,Rizza Robert A.1,Bjornsen Susan S.1,Green Erin M.4,Bryant Sandra C.4,Smith Steven A.13,

Affiliation:

1. Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota

2. Addenbrookes Hospital, Cambridge, U.K

3. Division of Health Care Policy and Research and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota

4. Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota

Abstract

OBJECTIVE—The Mayo Health System Diabetes Translation Project sought to assess models of community-based diabetes care and use of a diabetes electronic management system (DEMS). Planned care is a redesigned model of chronic disease care that involves guideline implementation, support of self-management, and use of clinical information systems. RESEARCH DESIGN AND METHODS—We studied adult diabetic patients attending three primary care practice sites in Wisconsin and Minnesota. We implemented planned care at all sites and DEMS in the practice of 16 primary care providers. We assessed quality of diabetes care using standard indicators for 200 patients randomly selected from each site at baseline and at 24 months of implementation. We used multivariable analyses to estimate the association between planned care and DEMS and each quality indicator. RESULTS—Planned care was associated with improvements in measurement of HbA1c (odds ratio 7.0 [95% CI 4.2–11.6]), HDL cholesterol (5.6 [4.1–7.5]), and microalbuminuria (5.3 [3.5–8.0]), as well as the provision of tobacco advice (6.9 [4.7–10.1]), among other performance measures. DEMS use was associated with improvements in all indicators, including microalbuminuria (3.2 [1.9–5.2]), retinal examination (2.4 [1.5–3.9]), foot examinations (2.3 [1.2–4.4]), and self-management support (2.6 [1.7–3.8]). Although planned care was associated with improvements in metabolic control, we observed no additional metabolic benefit when providers used DEMS. CONCLUSIONS—Planned care was associated with improved performance and metabolic outcomes in primary care. DEMS use augmented the impact of planned care on performance outcomes but not on metabolic outcomes. Optimal identification of the best translation of evidence to diabetes practice will require longer follow-up or new care-delivery models.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference21 articles.

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2. Health Care Financing Administration: Solicitation of proposals for a demonstration project for the use of informatics, telemedicine, and education in the treatment of diabetes mellitus in the rural and inner-city Medicare populations. Fed Regist 63:13260–13262, 1998

3. Dinneen SF, Bjornsen SS, Bryant SC, Zimmerman BR, Gorman CA, Knudsen JB, Rizza RA, Smith SA: Towards an optimal model for community-based diabetes care: design and baseline data from the Mayo Health System Diabetes Translation Project. J Eval Clin Pract 6:421–429, 2000

4. American Diabetes Association: Provider Recognition Program. Available from http://www.diabetes.org/main/professional/recognition/default2.jsp. Accessed February 2002

5. Institute for Clinical Systems Improvement: Management of Type 2 Diabetes Mellitus. Bloomington, MN, Institute for Clinical Systems Improvement, 1998

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