Clinical trial NCT00258674: Improving Diabetes Care:Effectiveness of Physician Profiling and Care Coordination by a Diabetes Resource Nurse
Official title: A Randomized Trial of Strategies to Improve Diabetes Care: Effectiveness and Costs of Physician Profiling and Care Coordination by a Diabetes Resource Nurse
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diabetes Mellitus
Keywords: Diabetes
Care coordination
Case management
Physician profiling
Lead sponsor: Baylor Research Institute
Sponsor class: OTHER
Collaborators: name: American Diabetes Association
First posted: 2005-11-28
Enrollment: 1891
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The purpose of this study is to test the effectiveness of physician profiling and care coordination by a diabetes resource nurse in improving the quality of diabetes care.

Detailed description: HealthTexas Provider Network primary care practices with at least 10 Medicare diabetes patients over the age of 65 were randomized to one of 3 intervention arms: physician feedback of process measures using Medicare claims data ("Claims"); feedback of Medicare claims data plus clinical measures from medical record abstraction ("Claims+MR"); or both types of feedback plus a practice-based DRN ("DRN"). For the 12 months prior to the intervention and 12 months post-intervention, performance data on diabetes related processes of care (annual HbA1c testing, annual LDL cholesterol screening, annual hypertension screening, annual eye, foot, and renal assessment) and patient outcomes (HbA1c level, LDL cholesterol level, blood pressure) were collected from medical record abstraction and Medicare claims data. Pre-post change scores will be compared between intervention arms to examine effectiveness of physician profiling and care coordination by a diabetes resource nurse.

Eligibility criteria: Inclusion Criteria:

* age ≥ 65 years on January 1, 2000
* diagnosis of diabetes mellitus
* diabetes related visit to HTPN physician within the past year
* Resident of Texas
* Medicare insurance coverage

Exclusion Criteria:

* Patient chart not available for abstraction

Primary outcomes:
measure: Change Score for "HbA1c <9 Percent"
timeFrame: This measure compared baseline values (01/01/2000-12/31/2000) to follow-up values (01/01/2001-12/31/2001)
measure: Change Score for "LDL <100 mg/dL"
timeFrame: change from baseline (01/01/2000-12/31/2000) to follow-up (01/01/2001-12/31/2001)
measure: Change Score for "Blood Pressure (b.p.) <130/80 mmHg"
timeFrame: change from baseline (01/01/2000-12/31/2000) to follow-up (01/01/200112/31/2001)
Secondary outcomes:
measure: Change Score for "HbA1c Level"
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Diastolic Blood Pressure"
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "LDL Level"
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Systolic Blood Pressure"
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual HbA1c Assessment" (as Determined From Medical Record Review)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual Lipid Assessment" (as Determined From Medical Record Review)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual Blood Pressure Assessment" (as Determined From Medical Record Review)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual Foot Exam" (as Determined by Medical Record Review)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual Eye Exam" (as Determined From Medical Record Review)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual Renal Function Assessment" (as Determined From Medical Record Review)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual HbA1c Assessment" (as Determined From Medicare Claims Data)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual Eye Exam" (as Determined From Medicare Claims Data)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Annual Lipid Assessment" (as Determined From Medicare Claims Data)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
measure: Change Score for "Semiannual HbA1c Assessment" (as Determined From Medicare Claims Data)
timeFrame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
Other outcomes:
Locations:
city: Dallas
country: United States
facility: Baylor Health Care System Institute for Health Care Research and Improvement
state: Texas
Study officials:
affiliation: Baylor Health Care System Institute for Health Care Research and Improvement
name: David J Ballard, MD,MSPH,PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Hollander P, Nicewander D, Couch C, Winter D, Herrin J, Haydar Z, Ballard DJ. Quality of care of Medicare patients with diabetes in a metropolitan fee-for-service primary care integrated delivery system. Am J Med Qual. 2005 Nov-Dec;20(6):344-52. doi: 10.1177/1062860605280205.
citation: Herrin J, Nicewander DA, Hollander PA, Couch CE, Winter FD, Haydar ZR, Warren SS, Ballard DJ. Effectiveness of diabetes resource nurse case management and physician profiling in a fee-for-service setting: a cluster randomized trial. Proc (Bayl Univ Med Cent). 2006 Apr;19(2):95-102. doi: 10.1080/08998280.2006.11928137.