Complex professional interventions improved the process of care , but the effect on patient outcomes remained less clear because such outcomes were rarely assessed .
Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures .
Complex interventions in which patient education was added and /or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care .
CONCLUSIONS Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care .
The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care
Effect of multiple patient reminders in improving diabetic retinopathy screening. A randomized trial.
OBJECTIVE To determine whether multiple mailed patient reminders can produce an increase in the rate of diabetic retinal examinations ( DRE ) over that seen with a single reminder . RESEARCH DESIGN AND METHODS All diabetic members > or = 18 years who were enrolled in a large network-based health maintenance organization ( HMO ) in California from August 1996 to July 1997 were identified using cl aims and pharmacy data bases . Members who had no record of DRE in the HMO 's cl aims data base were then r and omized into two groups . Both groups received mailed educational material s and a reminder to obtain the examination . Their physician groups also received a letter explaining the program , current guidelines for DRE , and a list of their diabetes patients with their DRE status . The single intervention group received no additional reminders . The multiple intervention group received additional reminders at 3 , 6 , and 9 months after baseline if they continued with no record of service , as determined from the cl aims data base . RESULTS The study cohort comprised 19,523 diabetic members , which were r and omized into single ( n = 9,614 ) and multiple ( n = 9,909 ) intervention groups . There was an increase in monthly DRE rates after the intervention in August 1996 for both intervention groups . After the second reminder was sent to the multiple intervention group , the percentage of diabetic members receiving  DRE  was higher than the single intervention group . Rates before and after the third intervention were not significantly different , nor were monthly differences found . There was a significant difference in overall annual DRE rates between the groups ( P = 0.023 ) . CONCLUSIONS Multiple patient reminders are more effective than single reminders in improving DRE rates in a managed care setting . However , the improvement noted was clinical ly small and appeared only after the second reminder ; no incremental improvement was seen with additional reminders . Re sources used for multiple reminders aim ed at diabetic retinopathy might better be spent on other approaches to reducing complications of diabetes
Complex professional interventions improved the process of care , but the effect on patient outcomes remained less clear because such outcomes were rarely assessed .
Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures .
Complex interventions in which patient education was added and /or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care .
CONCLUSIONS Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care .
The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care