SimCare: Physician Intervention to Improve Diabetes Care
Condition: Diabetes Mellitus
MeSH terms: Diabetes Mellitus
Study type: Interventional

Summary: 
      This randomized trial will test the hypotheses that (a) a physician opinion leader
      intervention, (b) a "narrative process trace" physician feedback intervention, or (c) the
      combined intervention (a + b), are no more effective than (d) usual care in improving the
      clinical care of adult patients with type 2 diabetes.
    

Detailed description: 
      This randomized trial will test the hypothesis that (a) an influential physician feedback
      intervention, (b) a "narrative process trace" feedback intervention, or (c) the combined
      intervention (a + b), are no more effective than (d) usual care in improving the clinical
      care of adult patients with diabetes mellitus.

      The unit of randomization and the unit of analysis will be primary care physicians who have
      more than 10 adult patients with diabetes mellitus. The 162 physicians eligible for this
      study provide care to about 6,804 adults with diagnosed diabetes at 24 primary care clinics.
      The narrative process trace intervention uses automated medical record (AMR)-mounted clinical
      cases to assess physicians' diabetes care decisions, with results provided as feedback to
      physicians. The influential physician feedback intervention emphasizes individualized
      education of physicians, which will be guided by the narrative process trace in the combined
      intervention group. Usual care includes the use of a diabetes clinical guideline, use of a
      diabetes patient registry that provides key clinical data for each adult patient with
      diabetes, and access to clinic-based diabetes education nurses. We have shown in previous
      controlled studies that the guideline, diabetes registry, and clinic-based diabetes education
      nurses have failed to significantly improve diabetes care on a population basis, thus
      justifying the additional, stronger interventions that now will be tested.

      Dependent variables include glycemic control and cardiovascular risk reduction of all 3,360
      patients cared for by the 80 study physicians. Secondary analysis will assess rates of
      screening for microvascular complications. Physicians will be randomized in blocks based on
      specialty, number of diabetes patients, and years of practice experience. Hierarchical data
      analysis will be used to accommodate the nested data and propensity scores will be used to
      correct for selection effects and missing data. Results of this experiment will advance our
      theoretical understanding of physician behavior change and quantify cost and impact of three
      specific intervention strategies to improve chronic disease care in the primary care setting.
      The study will have substantial impact on clinical practice and policy whether the results
      are positive or negative. If successful, the interventions will be easily disseminated to
      other primary care practice settings.
    

Intervention name(s): Simulated case-based customized learning; Simulated case based customized learning + leader feedback
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Formal Analysis of Diabetes Practice Style, Using SimCare cases with Process Trace Feedback; Formal Analysis of Diabetes Practice Style, Using SimCare cases with Process Trace Feedback + Physician Opinion Leader Feedback Tailored to Provider's Specific Practice Style
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: physician intervention; diabetes mellitus; primary care; quality improvement; disease management