title: Simulated physician learning intervention to improve safety and quality of diabetes care: a randomized trial.
abstract: OBJECTIVE
  To assess two physician learning interventions designed to improve safety and quality of diabetes care delivered by primary care physicians (PCPs).
  
  
  METHODS
  This group randomized clinical trial included 57 consenting PCPs and their 2,020 eligible adult patients with diabetes. Physicians were randomized to no intervention (group A), a simulated case-based physician learning intervention (group B), or the same simulated case-based learning intervention with physician opinion leader feedback (group C). Dependent variables included A1C values, LDL cholesterol values, pharmacotherapy intensification rates in patients not at clinical goals, and risky prescribing events.
  
  
  RESULTS
  Groups B and C had substantial reductions in risky prescribing of metformin in patients with renal impairment (P = 0.03). Compared with groups A and C, physicians in group B achieved slightly better glycemic control (P = 0.04), but physician intensification of oral glucose-lowering medications was not affected by interventions (P = 0.41). Lipid management improved over time (P < 0.001) but did not differ across study groups (P = 0.67).
  
  
  CONCLUSIONS
  A simulated, case-based learning intervention for physicians significantly reduced risky prescribing events and marginally improved glycemic control in actual patients. The addition of opinion leader feedback did not improve the learning intervention. Refinement and further development of this approach is warranted.
authors.affiliation: HealthPartners Research Foundation, Minneapolis, Minnesota, USA. patrick.j.oconnor@healthpartners.com
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Joann M
authors.initials: JM
authors.lastname: Sperl-Hillen
authors.forename: Paul E
authors.initials: PE
authors.lastname: Johnson
authors.forename: William A
authors.initials: WA
authors.lastname: Rush
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Asche
authors.forename: Pradyumina
authors.initials: P
authors.lastname: Dutta
authors.forename: George R
authors.initials: GR
authors.lastname: Biltz
mesh_terms: D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D003198:Computer Simulation; D003327:Coronary Disease / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000628:therapy; D004501:Education, Medical / Q000592:standards; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007858:Learning; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education*; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D012449:Safety
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin