Carol M. Mangione, MD, MSPH; Robert B. Gerzoff, MS; David F. Williamson, PhD; W. Neil Steers, PhD; Eve A. Kerr, MD; Arleen F. Brown, MD, PhD; Beth E. Waitzfelder, PhD; David G. Marrero, PhD; R. Adams Dudley, MD, MBA; Catherine Kim, MD, MPH; William Herman, MD; Theodore J. Thompson, MS; Monika M. Safford, MD; Joe V. Selby, MD, MPH; TRIAD Study Group*
Mangione CM, Gerzoff RB, Williamson DF, Steers WN, Kerr EA, Brown AF, et al. The Association between Quality of Care and the Intensity of Diabetes Disease Management Programs. Ann Intern Med. 2006;145:107-116. doi: 10.7326/0003-4819-145-2-200607180-00008
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Published: Ann Intern Med. 2006;145(2):107-116.
Little is known about the effects of quality-of-care improvement programs on the process of care and outcomes of diabetes.
The study involved 8661 patients with diabetes, 63 provider groups, and 3 disease management strategies (provider feedback, reminders, and structured care). The quality measures included 8 processes of care, 3 intermediate diabetes outcomes, and medication management of these outcomes. More intense disease management strategies predicted higher measures of many processes of care but only 1 intermediate outcome and 1 medication management outcome.
The disease management strategies improved processes of care but not outcomes. Experts in quality improvement may need to refocus their efforts.
*Patients receiving care in one of the Translating Research into Action for Diabetes (TRIAD) study health plans and whose diabetes diagnosis was based on the following criteria: a diagnostic code for diabetes (for example, 2 or more outpatient visits with International Classification of Diseases, Ninth Revision, code 250.) or 1 or more inpatient stays with an associated diabetes code; results of laboratory studies suggestive of diabetes (for example, 2 or more hemoglobin A tests or diagnostic levels of hemoglobin A or fasting blood glucose); or a prescription for medications for diabetes (for example, insulin or an oral antidiabetic agent). †At the time of the survey, patients who met the initial criteria were included only if they verified that they had diabetes and received most of their diabetes care through the participating TRIAD health plan. ‡Participants cared for under direct contracting agreements with health plans rather than in physician groups were assigned a value of 0 for each care management strategy at the physician group level.
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