title: A multifaceted intervention in support of diabetes treatment guidelines: a cont trial.
abstract: OBJECTIVE
  in an academic family practice clinic, we performed a controlled trial of a multifaceted intervention versus usual care for managing diabetes. Providers received didactic training and computerized compliance feedback to support staged diabetes management, an evidenced-based approach to diabetes care.
  
  
  METHODS
  one firm of the clinic practice received the intervention, the other served as the control group during a 14-month baseline period and a 14-month study period. HbA1(c) was the principal outcome measure.
  
  
  RESULTS
  there was a significant 0.71% difference in change in HbA1(c) values between the intervention and control firms (P=0.02). The subgroup with the greatest improvement in HbA1(c) was those subjects who started the intervention with a HbA1(c) above 8%. The overall improvement in glycemic control could not be explained by differences in visit frequency or the aggressiveness of drug therapy. There were no changes in healthcare utilization or costs between the two firms.
  
  
  CONCLUSIONS
  in an academic family practice clinic, a multifaceted intervention in support of diabetes treatment guidelines modestly improved glycemic control without incurring additional costs. The improvement was mostly due to mitigation of the natural deterioration in control usually seen. Further efforts are required to involve all patients in co-managing their diabetes.
authors.affiliation: Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356176, Seattle, WA 98195, USA. ihirsch@u.washington.edu
authors.forename: Irl B
authors.initials: IB
authors.lastname: Hirsch
authors.forename: Harold I
authors.initials: HI
authors.lastname: Goldberg
authors.forename: Allan
authors.initials: A
authors.lastname: Ellsworth
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Evans
authors.forename: Christian D
authors.initials: CD
authors.lastname: Herter
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: Mary
authors.initials: M
authors.lastname: Mullen
authors.forename: William E
authors.initials: WE
authors.lastname: Neighbor
authors.forename: Allen D
authors.initials: AD
authors.lastname: Cheadle
mesh_terms: D001794:Blood Pressure; D001835:Body Weight; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D030141:Feedback, Psychological; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin