It is likely that investments at the social context level will also help to decrease the development of barriers at the organisational context level , especially by increasing staff involvement and satisfaction .
Background Integrated care interventions for chronic conditions can lead to improved outcomes , but it is not clear when and why this is the case .
This study aims to answer the following two research questions : First , what are the context , mechanisms and outcomes of integrated care for people with type 2 diabetes ?
Second , what are the relationships between context , mechanisms and outcomes of integrated care for people with type 2 diabetes ?
A web-based diabetes intervention for physician: a cluster-randomized effectiveness trial.
OBJECTIVE To determine the effectiveness of a provider-based education and implementation intervention for improving diabetes control . DESIGN Cluster-r and omized trial with baseline and follow-up cross sections of diabetes patients in each participating physician 's practice . SETTING Eleven US Southeastern states , 2006 - 08 . PARTICIPANTS Two hundred and five rural primary care physicians . INTERVENTION Multi-component interactive intervention including Web-based continuing medical education , performance feedback and quality improvement tools . Primary Outcome Measures ' Acceptable control ' [ hemoglobin A1c ≤9 % , blood pressure ( BP ) < 140/90 mmHg , low-density lipoprotein cholesterol ( LDL ) < 130 mg/dl ] and ' optimal control ' ( A1c < 7 % , BP < 130/80 mmHg , LDL < 100 mg/dl ) . RESULTS Of 364 physicians attempting to register , 205 were r and omized to the intervention ( n= 102 ) or control arms ( n= 103 ) . Baseline and follow-up data were provided by 95 physicians ( 2127 patients ) .  The proportion of patients with A1c ≤9 % was similar at baseline and follow-up in both the control [ adjusted odds ratio ( AOR ) : 0.94 ; 95 % confidence interval ( CI ) : 0.61 , 1.47 ] and intervention arms [ AOR : 1.16 ( 95 % CI : 0.80 , 1.69 ) ] ; BP < 140/90 mmHg and LDL < 130 mg/dl were also similar at both measurement points ( P= 0.66 , P= 0.46 ; respectively ) . We observed no significant effect on diabetes control attributable to the intervention for any of the primary outcome measures . Intervention physicians engaged with the Website over a median of 64.7 weeks [ interquartile range ( IQR ) : 45.4 - 81.8 ) for a median total of 37 min ( IQR : 16 - 66 ) . CONCLUSIONS A wide-reach , low-intensity , Web-based interactive multi-component intervention did not improve control of glucose , BP or lipids for patients with diabetes of physicians practicing in the rural Southeastern US
It is likely that investments at the social context level will also help to decrease the development of barriers at the organisational context level , especially by increasing staff involvement and satisfaction .
Background Integrated care interventions for chronic conditions can lead to improved outcomes , but it is not clear when and why this is the case .
This study aims to answer the following two research questions : First , what are the context , mechanisms and outcomes of integrated care for people with type 2 diabetes ?
Second , what are the relationships between context , mechanisms and outcomes of integrated care for people with type 2 diabetes ?