title: Implementing practice guidelines for diabetes care using problem-based learning. A prospective controlled trial using firm systems.
abstract: OBJECTIVE
  A controlled trial with 15-month follow-up was conducted in two outpatient clinics to study the effects of using the problem-based learning technique to implement a diabetes clinical practice guideline.
  
  
  METHODS
  A total of 144 patients with type 2 diabetes aged 25-65 years in two internal medicine outpatient clinics were enrolled in the study. African-Americans and Hispanics made up > 75% of the patients. Doctors and staff in one of the clinics were trained in the use of a clinical practice guideline based on Staged Diabetes Management. A problem-based learning educational program was instituted to reach consensus on a stepped intensification scheme for glycemic control and to determine the standards of care used in the clinic. HbA1c was obtained at baseline and at 9 and 15 months after enrollment.
  
  
  RESULTS
  At 9 months, there was a mean -0.90% within-subject change in HbA1c in the intervention group, with no significant changes in the control group. The 15-month mean within-subject change in HbA1c of -0.62% in the intervention group was also significant. Among intervention patients, those with the poorest glycemic control at baseline realized the greatest benefit in improvement of HbA1c. The intervention group also exhibited significant changes in physician adherence with American Diabetes Association standards of care.
  
  
  CONCLUSIONS
  Clinical practice guidelines are an effective way of improving the processes and outcomes of care for patients with diabetes. Problem-based learning is a useful strategy to gain physician support for clinical practice guidelines. More intensive interventions are needed to maintain treatment gains.
authors.affiliation: Clinical Practices Evaluation and Management, Baystate Medical Center, Springfield, MA 01199, USA. evan.benjamin@bhs.org
authors.forename: E M
authors.initials: EM
authors.lastname: Benjamin
authors.forename: M S
authors.initials: MS
authors.lastname: Schneider
authors.forename: K T
authors.initials: KT
authors.lastname: Hinchey
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000628:therapy*; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino; D006801:Humans; D007388:Internal Medicine / Q000592:standards; D008297:Male; D008404:Massachusetts; D008505:Medical Staff, Hospital / Q000193:education*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D018794:Problem-Based Learning; D011785:Quality Assurance, Health Care; D044465:White People
chemical_list: D006442:Glycated Hemoglobin