Patient Based Strategy to Reduce Errors in Diabetes Care

Study Overview
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Brief Summary
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This project evaluates a HPMG effort to reduce error rates through customized direct feedback of diabetes quality of care data to diabetes patients and their physicians. HPMG has routinely provided patients with personalized feedback of glucose and cholesterol test results since about 1997. This project will implement and evaluate the impact of this intervention on diabetes medical error rates and resource use.

Detailed Description
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The project, Patient-Based Strategy to Reduce Errors in Diabetes Care (referred to as MOVES), addresses issues of overuse, under use, or misuse of care for adults with diabetes. This combination research and translation project has been developed as a component of the Pursuing Perfection initiative of HealthPartners Medical Group, with the close collaboration of HPMG leadership. HealthPartners Medical Group is widely regarded as a national leader in diabetes care, with dramatic improvements in both glucose control and cholesterol control over the past 8 years [Graphs]. The MOVES study is attempting to activate patients with diabetes to be more involved in their care. To help patients do this, HPMG sends patients a customized summary of their care. The summary includes a graph of recent glucose and cholesterol test results and specific suggestions that may improve care. In many cases, a visit with the patient's personal physician is encouraged to assure ongoing progress towards important evidence-based goals in diabetes care. Physicians also receive a matched communication that indicates areas for potential improvement and makes technical suggestions for care based on the Staged Diabetes Management © protocols. The project tries to ally expert judgment with the physician's personal knowledge of a patient. It is felt that this approach is critical to assessing what the best improvement strategy may be in each individual case. This inexpensive customized intervention has potential to be widely disseminated and can be seamlessly integrated with other interventions to further achievement of clinical goals. The results are relevant to patients, clinicians, payers, and policymakers.

Official Title
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Patient Based Strategy to Reduce Errors in Diabetes Care

Conditions
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Diabetes Mellitus

Intervention / Treatment
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* Behavioral: Customized Physician Intervention
* Behavioral: Customized Patient Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For physician intervention inclusion criteria included; 1)primary care (general internist or family) physician in HealthPartners Medical Group. 2)Provided ongoing care to 20 or more adult patients with diabetes. For patients inclusion criteria included; An established diagnosis of diabetes based on either (a) two or more ICD-9 diagnosis codes for diabetes in a 12-month period of time, or (b) a filled prescription for a diabetes-specific drug within a 12-month period of time. In addition, participating patients met all of the following criteria: (a) age less than 75 years, (b) Charlson comorbidity score of 3 or less, (c) linked to the a primary care physician who was participating in the study in two consecutive calendar years, (d) had pharmacy coverage at the time of the intervention and for the previous 12-month period, and (e) had either HBA1c > 7% or LDL > 130 mg/dl (or LDL > 100 mg/dl if the patient also had CHD). Exclusion Criteria: none

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Customized Physician Intervention|nan|
|Behavioral: Customized Patient Intervention|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The following dependant variables were measured in this study; |  |  | 
| Diabetes medical error in the 12 months post-intervention, Glycated hemoglobin (A1c) values and A1c test rates in the 12 months post-intervention, and |  |  | 
| LDL-cholesterol levels and test rates in the 12 months post-intervention. |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Age |  |  | 
| Gender |  |  | 
| Charlson comorbidity score |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes mellitus, Medical error rates, Pharmacotherapy