title: Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project.
abstract: BACKGROUND
  Type 2 diabetes mellitus is a complex, progressive disease which requires a variety of quality improvement strategies. Limited information is available on the feasibility and effectiveness of interdisciplinary diabetes care teams (IDCT) operating on the interface between primary and specialty care. A first study hypothesis was that the implementation of an IDCT is feasible in a health care setting with limited tradition in shared care. A second hypothesis was that patients who make use of an IDCT would have significantly better outcomes compared to non-users of the IDCT after an 18-month intervention period. A third hypothesis was that patients who used the IDCT in an Advanced quality Improvement Program (AQIP) would have significantly better outcomes compared to users of a Usual Quality Improvement Program (UQIP).
  
  
  METHODS
  This investigation comprised a two-arm cluster randomized trial conducted in a primary care setting in Belgium. Primary care physicians (PCPs, n = 120) and their patients with type 2 diabetes mellitus (n = 2495) were included and subjects were randomly assigned to the intervention arms. The IDCT acted as a cornerstone to both the intervention arms, but the number, type and intensity of IDCT related interventions varied depending upon the intervention arm.
  
  
  RESULTS
  Final registration included 67 PCPs and 1577 patients in the AQIP and 53 PCPs and 918 patients in the UQIP. 84% of the PCPs made use of the IDCT. The expected participation rate in patients (30%) was not attained, with 12,5% of the patients using the IDCT. When comparing users and non-users of the IDCT (irrespective of the intervention arm) and after 18 months of intervention the use of the IDCT was significantly associated with improvements in HbA1c, LDL-cholesterol, an increase in statins and anti-platelet therapy as well as the number of targets that were reached. When comparing users of the IDCT in the two intervention arms no significant differences were noted, except for anti-platelet therapy.
  
  
  CONCLUSIONS
  IDCT's operating on the interface between primary and specialty care are associated with improved outcomes of care. More research is required on what team and program characteristics contribute to improvements in diabetes care.
  
  
  BACKGROUND
  NTR 1369.
authors.affiliation: Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium. liesbeth.borgermans@med.kuleuven.be
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Borgermans
authors.forename: Geert
authors.initials: G
authors.lastname: Goderis
authors.forename: Carine
authors.initials: C
authors.lastname: Van Den Broeke
authors.forename: Geert
authors.initials: G
authors.lastname: Verbeke
authors.forename: An
authors.initials: A
authors.lastname: Carbonez
authors.forename: Anna
authors.initials: A
authors.lastname: Ivanova
authors.forename: Chantal
authors.initials: C
authors.lastname: Mathieu
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
authors.forename: Jan
authors.initials: J
authors.lastname: Heyrman
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D001530:Belgium; D003266:Continuity of Patient Care; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D013038:Specialization; D016896:Treatment Outcome