Improving chronic care of type 2 diabetes using teams of interprofessional learners.
OBJECTIVE
To improve the care and outcomes of adult patients with type 2 diabetes by teaching interprofessional teams of learners the principles and practices of the Improving Chronic Illness Care Model.


METHODS
The study population consisted of 384 adult patients with type 2 diabetes. The study design was a nonrandomized, parallel-group, clinical trial conducted during 18 months in the University of California, San Francisco internal medicine clinics. Interprofessional team care provided by primary care internal medicine residents, nurse practitioner students, and pharmacy students was compared with usual care by internal medicine residents only. Processes of care, clinical status, and health utilization were measured in both patient groups. Learner outcomes also were assessed and compared.


RESULTS
At study completion, intervention patients more frequently received assessments of glycosolated hemoglobin (79% versus 67%; P=.01), LDL-C (69% versus 55%; P=.009), blood pressure (86% versus 79%; P=.08), microalbuminuria (40% versus 30%; P=.05), smoking status assessment (43% versus 31%; P=.02), and foot exams (38% versus 20%; P=.0005). Intervention patients had more planned general medicine visits (7.9+/-6.2 versus 6.2+/-5.7; P=.006) than did control patients. Interprofessional learners rated themselves significantly higher on measures of accomplishment, preparation, and success for chronic care than did the usual care learners.


CONCLUSIONS
Interprofessional team care by learners was effective in improving quality of care for adult patients with diabetes treated in general medicine clinics. The chronic illness framework resulted in more appropriate health care utilization.
Department of Community Health Systems, University of California, San Francisco (UCSF), San Francisco, California 94143-0608, USA. susan.janson@nursing.ucsf.edu
Susan L
SL
Janson
Molly
M
Cooke
Kelly Wong
KW
McGrath
Lisa A
LA
Kroon
Susan
S
Robinson
Robert B
RB
Baron
D002140:California; D008078:Cholesterol, LDL / Q000097:blood; D002908:Chronic Disease; D003479:Curriculum; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D033183:Interdisciplinary Communication; D007858:Learning; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012648:Self Care; D016896:Treatment Outcome; D014481:United States
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin