title: Improvements in patient-reported outcomes associated with an intervention to enhance quality of care for rural patients with type 2 diabetes: results of a controlled trial.
abstract: OBJECTIVE
  The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes.
  
  
  METHODS
  We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta, Canada. The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers. Clinical and patient-reported outcomes were assessed after 6 months. Patient-reported outcomes included changes in health-related quality of life (Health Utilities Index Mark 3 [HUI3]), satisfaction with care, lifestyle (Diabetes Lifestyle Form), and adherence to self-care activities. Analysis of covariance was used to assess differences over time between the control and intervention regions.
  
  
  RESULTS
  A total of 200 intervention and 172 control subjects were included in this analysis. After adjusting for important clinical and demographic differences, a statistically significant and clinically important improvement in the overall HUI3 score was seen at the 6-month follow-up in the intervention region (0.06 [95% CI 0.02-0.10]) compared with the control region (0.01 [-0.04 to 0.04]) (P = 0.03 for the difference between groups). Satisfaction with general medical care (P < 0.001 between groups) and diabetes care (P < 0.001 between groups) increased among patients in the intervention region compared with the control region. Self-efficacy, attitudes, and beliefs about diabetes control all increased in the intervention region when compared with the control region, but adherence to self-care activities did not.
  
  
  CONCLUSIONS
  A provider-level intervention directed at improving quality of clinical care for patients with type 2 diabetes also had a favorable impact on overall health-related quality of life, satisfaction with care, and other humanistic outcomes.
authors.affiliation: Public Health Sciences, and Institute of Health Economics, University of Alberta, #1200 10405 Jasper Avenue, Edmonton, Alberta, Canada T5J 3N4.
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Maddigan
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Guirguis
authors.forename: Richard Z
authors.initials: RZ
authors.lastname: Lewanczuk
authors.forename: T K
authors.initials: TK
authors.lastname: Lee
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Toth
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000416:Alberta; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011785:Quality Assurance, Health Care; D019035:Rural Health Services / Q000592:standards; D012424:Rural Population; D012959:Socioeconomic Factors; D016896:Treatment Outcome