The impact of planned care and a diabetes electronic management system on community-based diabetes care: the Mayo Health System Diabetes Translation Project.
OBJECTIVE
The Mayo Health System Diabetes Translation Project sought to assess models of community-based diabetes care and use of a diabetes electronic management system (DEMS). Planned care is a redesigned model of chronic disease care that involves guideline implementation, support of self-management, and use of clinical information systems.


METHODS
We studied adult diabetic patients attending three primary care practice sites in Wisconsin and Minnesota. We implemented planned care at all sites and DEMS in the practice of 16 primary care providers. We assessed quality of diabetes care using standard indicators for 200 patients randomly selected from each site at baseline and at 24 months of implementation. We used multivariable analyses to estimate the association between planned care and DEMS and each quality indicator.


RESULTS
Planned care was associated with improvements in measurement of HbA(1c) (odds ratio 7.0 [95% CI 4.2-11.6]), HDL cholesterol (5.6 [4.1-7.5]), and microalbuminuria (5.3 [3.5-8.0]), as well as the provision of tobacco advice (6.9 [4.7-10.1]), among other performance measures. DEMS use was associated with improvements in all indicators, including microalbuminuria (3.2 [1.9-5.2]), retinal examination (2.4 [1.5-3.9]), foot examinations (2.3 [1.2-4.4]), and self-management support (2.6 [1.7-3.8]). Although planned care was associated with improvements in metabolic control, we observed no additional metabolic benefit when providers used DEMS.


CONCLUSIONS
Planned care was associated with improved performance and metabolic outcomes in primary care. DEMS use augmented the impact of planned care on performance outcomes but not on metabolic outcomes. Optimal identification of the best translation of evidence to diabetes practice will require longer follow-up or new care-delivery models.
Montori
Victor M
VM
Division of Endocrinology, Diabetes, Metabolism and Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Dinneen
Sean F
SF
Gorman
Colum A
CA
Zimmerman
Bruce R
BR
Rizza
Robert A
RA
Bjornsen
Susan S
SS
Green
Erin M
EM
Bryant
Sandra C
SC
Smith
Steven A
SA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards*; D003628:Database Management Systems; D003920:Diabetes Mellitus / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D008910:Minnesota; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care