OBJECTIVE: There is a well-documented gap between diabetes care guidelines and the services received by patients in almost all health
care settings. This project reports initial results from a computer-assisted, patient-centered intervention to improve the
level of recommended services received by patients from a wide variety of primary care providers.
DESIGN AND SETTINGS: Eight hundred eighty-six patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes
Priority Program. Physicians were stratified and randomized to intervention or control conditions and evaluated on 2 primary
outcomes: number of recommended laboratory screenings and recommended patient-centered care activities completed. Secondary
outcomes were evaluated using the Problem Areas in Diabetes scale and the Patient Health Questionnaire (PHQ)-9 depression
scale, and the RE-AIM framework was used to evaluate potential for dissemination.
RESULTS: The program was well-implemented and significantly improved both number of recommended laboratory assays (3.4 vs 3.1; P<.001) and patient-centered aspects of diabetes care patients received (3.6 vs 3.2; P<.001) compared to those in randomized control practices. Activities that were increased most were foot exams (follow-up rates
of 80% vs 52%; P<.003) and nutrition counseling (76% vs 52%; P<.001).
CONCLUSIONS: Patients are very willing to participate in a brief computer-assisted intervention that is effective in enhancing quality
of diabetes care. Staff in primary care offices can consistently deliver an intervention of this nature, but most physicians
were unwilling to participate in this translation research study.
Key words randomized controlled trial - health care quality - diabetes care - computer - translation to practice
This work was supported by the Agency for Health, Research and Quality (AHRQ; HS10123).