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K.M. Venkat Narayan, MD, MPH, MBA; Leonard Jack Jr., PhD; and Christine Laine, MD, MPH, Editors
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Supplement: Diabetes Translation and Public Health: 25 Years of CDC Research and Programs |1 June 2004

Diabetes Translation Research: Where Are We and Where Do We Want To Be? Free

K. M. Venkat Narayan, MD; Evan Benjamin, MD; Edward W. Gregg, PhD; Susan L. Norris, MD; Michael M. Engelgau, MD

K. M. Venkat Narayan, MD
From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Evan Benjamin, MD
From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Edward W. Gregg, PhD
From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Susan L. Norris, MD
From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Michael M. Engelgau, MD
From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From the Centers for Disease Control and Prevention, Atlanta, Georgia.

    Acknowledgments: The authors thank Farah Chowdhury for her assistance in preparing this manuscript.

    Potential Financial Conflicts of Interest: None disclosed.

    Requests for Single Reprints: K.M. Venkat Narayan, MD, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-10, 4770 Buford Highway NE, Atlanta, GA 30341.

    Current Author Addresses: Drs. Narayan, Gregg, Norris, and Engelgau: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-10, 4770 Buford Highway NE, Atlanta, GA 30341.

    Dr. Benjamin: Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.


K.M. Venkat Narayan, MD, MPH, MBA; Leonard Jack Jr., PhD; and Christine Laine, MD, MPH, Editors
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Abstract

Translation research transforms currently available knowledge into useful measures for everyday clinical and public health practice. We review the progress in diabetes translation research and identify future challenges and opportunities in this field. Several promising interventions to optimize implementation of efficacious diabetes treatments are available. Many of these interventions, singly or in combination, need to be more formally tested in larger randomized or quasi-experimental practical trials using outcomes of special interest to patients (for example, patient satisfaction and quality of life) and policymakers (for example, cost and cost-effectiveness). The long-term outcomes (such as morbidity, mortality, quality of life, and costs) of strategies aimed at improving diabetes care must be assessed. Translation research also needs to incorporate ways of studying complex systems of care. The challenges and opportunities offered by translation research are tremendous.

We have previously described translation research as comprehensive applied research that strives to translate the available knowledge and make it useful in everyday clinical and public health practice (1). Translation research aims to assess implementation of standards of care, understand the barriers to their implementation, and intervene throughout all levels of health care delivery and public health to improve quality of care and health outcomes, including quality of life.
Translation research may be viewed as an extension of effectiveness research, but in its evolution it has encompassed new dimensions (the Figure shows translation research in the context of other types of research and public health assessments). Translation research 1) is oriented toward understanding solutions to real-world health care delivery problems (as opposed to basic science, epidemiology, and public health surveillance, which aim to characterize the problem); 2) is interested in impact, generalizability, and transferability (for example, application of results to most people with the condition, issues concerning application to diverse settings and situations, and the extent of spread and equity in implementation); 3) focuses on assessing effectiveness and its influence on process and outcomes, and the sustainability of long-term implementation in real-world settings; and 4) emphasizes efficiency (that is, relative value under conditions of finite resources), equity, and facilitation of optimal health and health care for as many people as possible.
Figure.

Translation research in the context of other types of research and public health assessments.

Image: 37ff1
Diabetes is a chronic disease with complex causes, manifestations, complications, and management. The disease imposes huge public health and economic burdens despite the availability of numerous efficacious treatments, in part because these treatments are often suboptimally applied in practice (1-4). Recent evidence also provides efficacious interventions to prevent or delay diabetes in high-risk groups, but translating these interventions into practice brings additional challenges (5). All of these factors make diabetes a prototype of chronic diseases, which are the major cause of death, illness, and reduced quality of life in both industrialized and industrializing nations.
Over the past decade, the content and implementation of translation research have evolved considerably (2, 6). The field continues to change and adapt to modern realities and challenges, and today the need for translation research is greater than ever before. We briefly review examples of interventions to reduce the burden of diabetes, review the progress in diabetes translation research, and identify the future challenges and opportunities for this field. Without question, the control of diabetes and other chronic diseases will be a high-priority public health issue in the 21st century.

Gaps in Diabetes Care

Two articles in this supplement describe the enormous health and economic burden posed by diabetes (7, 8). Fortunately, several efficacious strategies to prevent or delay diabetes complications have emerged during the past decade, including control of blood pressure, lipids, and glycemia; early detection and treatment of diabetic retinopathy, nephropathy, and foot disease; therapy with aspirin and angiotensin-converting enzyme (ACE) inhibitors; and influenza and pneumococcal vaccines (1, 2). Although many of these treatments are relatively cost-effective, their implementation remains suboptimal. According to national data, in the United States there is a considerable gap between recommended diabetes care and the care patients actually receive (4). In 1988–1995, for example, 18% of diabetic persons age 18 to 75 years had a hemoglobin A1c level greater than 9.5%, 34.3% were hypertensive (blood pressure ≥ 140/90 mm Hg), and 58% had a low-density lipoprotein cholesterol level of 3.35 mmol/L or greater (≥ 130 mg/dL). In addition, 63% had a dilated eye examination in the previous year, 54.8% had a foot examination; just 38% were self-monitoring their blood glucose levels; and only 46% and 27% had received influenza vaccine and pneumococcal vaccine, respectively. More recent data, however, indicate encouraging improvement, with increases in the use of eye examination (increased 7 percentage points), foot examination (6 percentage points), self-monitoring of blood glucose (15 percentage points), influenza vaccine (5 percentage points), and pneumococcal vaccine (15 percentage points) (9).

Barriers

The numerous barriers to care at the level of the provider, the patient, and the system help to explain the suboptimal diabetes care in the United States. At the provider level, forgetfulness and time constraints (10-12), a perception of patients as nonadherent (10, 13, 14), and inadequate knowledge (15, 16) may act as barriers. In addition, a study found that primary care providers perceived diabetes as requiring more resources and being more difficult to treat than hypertension (17). The disease is also often accompanied by many comorbid conditions, whose demands for treatment compete with care for diabetes (18).
At the level of the patients, incomplete understanding of the gravity of diabetes, little motivation toward prevention (17, 19), insufficient time, and a lack of socioeconomic resources and support (15, 16, 20) are barriers.
At the level of the health care system, the status of diabetes as a chronic disease constitutes a potential barrier in a system that is better designed for acute care (20-22). In addition, our current health care system often lacks information systems to identify patients, track their status, and prompt providers on ongoing preventive care needs. Use of reminders or other tools to overcome forgetfulness and time constraints help but have not been common in practice (23-25).

Interventions

The challenge of providing effective diabetes care has thus far defied a simple solution. Already, however, small, regional studies have tested numerous provider-, system-, or patient-level interventions to improve care in primary care and community settings.

Providers

Health care providers need to know how to incorporate the latest research into their clinical practice. In addition, they need to feel empowered by believing that they have a role in improving the quality of care they provide; they also must feel that the care they offer has the highest scientific validity. Interventions that include an educational component for providers have been moderately successful at improving adherence to process measures. Interventions to educate providers, however, have usually been part of more complex interventions that also focus on systems and organization of practices, including performance feedback, reminder systems, and consensus development (26-28).
Clinical practice guidelines have been used in many settings (29, 30); most guidelines focus on stepped-intensification programs to improve glycemic control and on use of reminder checklists to improve adherence with screening and other processes of care. Unfortunately, guidelines alone have been only minimally effective in improving care (31), as have consensus recommendations disseminated through mass mechanisms (32). When included as part of a multifaceted strategy, however, clinical guidelines have been associated with more success (33, 34). Having providers take an active part in modifying and adapting national guidelines has also empowered providers to lead the translation of research into practice (26, 30). This type of consensus building for guidelines has been associated with improvements in glycemic control and adherence to such process measures as microalbuminuria and lipid levels. Finally, one study looked at the effect of combining provider educational meetings and materials with patient education (35). Hemoglobin A1c and blood pressure improved in the intervention group, but a similar study showed no benefit of combined provider and patient education (36).

Systems

System interventions using continuous quality improvement techniques focused on provider education and feedback and agreed-upon goals and guidelines have been used in managed and primary care settings (37-40). The use of guidelines to educate providers, combined with a performance feedback approach such as continuous quality improvement, has been successful (28, 41, 42).
The use of nurses to provide diabetes care (typically provided by physicians) has improved glycemic control in some patient populations (43, 44). These nurses have used detailed protocols under the supervision of attending physicians. One study used a nurse-administered telephone intervention to educate patients, monitor health status, and facilitate access to physicians (45).
The use of computerized reminder systems for providers alone or combined with a performance feedback program can improve outcomes for patients with diabetes (40, 46, 47). Patient tracking systems or other reminder systems to improve regular follow-up have also reduced no-show rates and improved rates of processes of care, such as retinal examination (44, 48, 49).
Dedicating blocks of time to diabetic patients in a primary care practice has improved both outcomes and processes of care (41, 50, 51). These cluster visit models are an efficient way to focus other providers' care, such as that of nutritionists, podiatrists, and educators, during the “diabetes clinic.”
Changing the medical record system can be an opportunity to improve the quality of care. An electronic medical record to enhance adherence to quality measures has been used in some settings. One study evaluated an electronic medical record system to facilitate communication between team members and consultants; the intervention group carried out more processes of care, including measurement of hemoglobin A1c and lipid levels (52). Use of an electronic medical record system to remind physicians to order tests has been effective when linked to multidisciplinary quality improvement efforts (53). Finally, nonautomated systems such as telephone and mailing reminders, chart stickers, and flow sheets have helped prompt both providers and patients for needed screening tests (54-56).

Patients

Interventions that empower patients can be successful components of diabetes programs (57, 58), and the addition of patient-oriented interventions to provider- and system-based programs can lead to improvements in process and outcome measures (56). One study found improved outcomes when nurses called patients monthly to educate them, remind them of their medical regimen, and reinforce upcoming appointments (45).
A more systems-oriented approach has included manual or computerized systems that remind patients to make follow-up appointments and to prompt staff to generate reminder cards for patients (46, 59). These programs improve adherence to follow-up and enhance efficiency for office practices. Reminders for patients improved the rate of annual dilated eye examinations in one setting (49); this study found that calling patients was superior to repeatedly sending letters about missed appointments. Use of a prompting database that sent reminders directly to patients to have them provide blood and urine sample increased annual measurements of hemoglobin A1c and screening for microalbuminuria (59).
Education in self-management, including skill building, has helped improve glycemic control and patients' abilities to cope with chronic disease. Specific teaching programs have shown improvements in quality of life, glycemic control, and adherence to screening recommendations (60-63).

Discussion

Like most chronic diseases, diabetes is complex in its biology. This complexity; the lifelong nature of the disease; the numerous challenges in treating and managing it; and the importance and interplay of the role of the patient, the provider, and the system, the task of delivering high-quality diabetes care can seem daunting indeed. Fortunately, the scientific base for preventing the complications of diabetes is large and increasing. We have direct evidence that currently available efficacious treatments can be comprehensively implemented in real-life settings, and this can reduce vascular events by at least 50% (64). We also have evidence that type 2 diabetes itself may be prevented or substantially delayed (5).
Translation research is a way of making evidence a part of clinical and public health practice. Although the field of translation research has progressed considerably, several new avenues must be pursued to meet the challenges of chronic disease control in the 21st century. Beginning with studies aimed at documenting quality of care using nonstandard measures, the field has evolved toward better and more standard characterization of quality of care and better understanding of barriers to improvements in quality of care. Numerous small studies have tested simple patient-, provider-, and system-level interventions to improve care. Some of the more advanced development in diabetes translation includes multicenter studies using a common protocol and the testing of integrated models of care. Other studies have documented the feasibility of implementing system-wide re-engineering and its beneficial effect on diabetes care (65). The long-term impact on health outcomes, quality of life, and cost of strategies aimed at improving diabetes care at patient, provider, and system levels is not known.
Small single-site studies have shown the promise of several interventions at the patient, provider, or system level for improving care. Where individual studies may provide less compelling evidence on the benefit of interventions, comprehensive systematic reviews and meta-analysis may play a vital role. For example, a systematic review by Renders and colleagues (66) found that multifaceted professional interventions may enhance the performance of providers in managing diabetes care; organizational interventions that involve regular calling and reviewing of patients (central computerized tracking systems or nurses who regularly contact the patient) can also improve diabetes management; patient-oriented interventions can lead to improved patient outcomes; and nurses can play an important role in patient-oriented interventions by educating patients or facilitating patient adherence to treatment.
A variety of these interventions, alone or in combination, must be more formally tested in larger randomized practical trials or replicated in several settings so that the findings are more generalizable. Such studies should include multiple outcomes, including those of special interest to patients (such as patient satisfaction and quality of life) and policymakers (such as cost and cost-effectiveness). One ongoing observational, multicenter cohort study, TRIAD (Translating Research Into Action for Diabetes) (6), is examining many of these issues.
Over the past century, our health care system has evolved from the management of acute diseases and is not optimally suited for managing chronic disorders. The Institute of Medicine (67) has argued strongly that newer systems of care and newer ways of thinking are needed to tackle complex diseases such as diabetes. This means that translation research, which should incorporate the principles of complex systems (68-71), must be designed to understand the system as a whole and not simply its parts. The model for process of change in a simple mechanical system is woefully inadequate for dealing with the complex, interactive, interconnected, and adaptive systems in which the prevention and treatment of diabetes operate. As a result, we will need translation research that is sufficiently multidisciplinary to include new science such as complexity, leadership, and the management of change while continuing to draw on epidemiology, health service research, sociology, policy science, economics, operational research, and other fields. The challenges and opportunities offered by translation research are tremendous, and we need to grapple with them to stop the onrushing tide of diabetes both in the United States and around the world.

References

  1. Narayan
    KM
    Gregg
    EW
    Engelgau
    MM
    Moore
    B
    Thompson
    TJ
    Williamson
    DF
    et al
    Translation research for chronic disease: the case of diabetes.
    Diabetes Care
    2000
    23
    1794
    8
    PubMed
    CrossRef
    PubMed
  2. Garfield
    SA
    Malozowski
    S
    Chin
    MH
    Venkat
    Narayan
    KM
    Glasgow
    RE
    Green
    LW
    et al
    Considerations for diabetes translational research in real-world settings.
    Diabetes Care
    2003
    26
    2670
    4
    PubMed
    CrossRef
    PubMed
  3. Narayan
    KM
    Gregg
    EW
    Fagot-Campagna
    A
    Engelgau
    MM
    Vinicor
    F
    Diabetes—a common, growing, serious, costly, and potentially preventable public health problem.
    Diabetes Res Clin Pract
    2000
    50
    S77
    84
    PubMed
    CrossRef
    PubMed
  4. Saaddine
    JB
    Engelgau
    MM
    Beckles
    GL
    Gregg
    EW
    Thompson
    TJ
    Narayan
    KM
    A diabetes report card for the United States: quality of care in the 1990s.
    Ann Intern Med
    2002
    136
    565
    74
    CrossRef
    PubMed
  5. Knowler
    WC
    Barrett-Connor
    E
    Fowler
    SE
    Hamman
    RF
    Lachin
    JM
    Walker
    EA
    et al
    Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
    N Engl J Med
    2002
    346
    393
    403
    PubMed
    CrossRef
    PubMed
  6. TRIAD Study Group
    The Translating Research Into Action for Diabetes (TRIAD) study: a multicenter study of diabetes in managed care.
    Diabetes Care
    2002
    25
    386
    9
    PubMed
    CrossRef
    PubMed
  7. Engelgau
    MM
    Geiss
    LS
    Saaddine
    JB
    Boyle
    JP
    Benjamin
    SM
    Gregg
    EW
    et al
    The evolving diabetes burden in the United States.
    Ann Intern Med
    2004
    140
    945
    50
    CrossRef
    PubMed
  8. Zhang
    P
    Engelgau
    MM
    Norris
    SL
    Gregg
    EW
    Narayan
    KM
    Application of economic analysis to diabetes and diabetes care.
    Ann Intern Med
    2004
    140
    972
    7
    CrossRef
    PubMed
  9. Preventive-care practices among persons with diabetes—United States, 1995 and 2001.
    MMWR Morb Mortal Wkly Rep
    2002
    51
    965
    9
    PubMed
    PubMed
  10. Chin
    MH
    Zhang
    JX
    Merrell
    K
    Diabetes in the African-American Medicare population. Morbidity, quality of care, and resource utilization.
    Diabetes Care
    1998
    21
    1090
    5
    PubMed
    CrossRef
    PubMed
  11. McFarlane
    SI
    Jacober
    SJ
    Winer
    N
    Kaur
    J
    Castro
    JP
    Wui
    MA
    et al
    Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers.
    Diabetes Care
    2002
    25
    718
    23
    PubMed
    CrossRef
    PubMed
  12. McVea
    K
    Crabtree
    BF
    Medder
    JD
    Susman
    JL
    Lukas
    L
    McIlvain
    HE
    et al
    An ounce of prevention? Evaluation of the ‘Put Prevention into Practice’ program.
    J Fam Pract
    1996
    43
    361
    9
    PubMed
    PubMed
  13. Dalewitz
    J
    Khan
    N
    Hershey
    CO
    Barriers to control of blood glucose in diabetes mellitus.
    Am J Med Qual
    2000
    15
    16
    25
    PubMed
    CrossRef
    PubMed
  14. Jacques
    CH
    Jones
    RL
    Problems encountered by primary care physicians in the care of patients with diabetes.
    Arch Fam Med
    1993
    2
    739
    41
    PubMed
    CrossRef
    PubMed
  15. Bernard
    AM
    Anderson
    L
    Cook
    CB
    Phillips
    LS
    What do internal medicine residents need to enhance their diabetes care?
    Diabetes Care
    1999
    22
    661
    6
    PubMed
    CrossRef
    PubMed
  16. Drass
    J
    Kell
    S
    Osborn
    M
    Bausell
    B
    Corcoran
    J
    Jr
    Moskowitz
    A
    et al
    Diabetes care for Medicare beneficiaries. Attitudes and behaviors of primary care physicians.
    Diabetes Care
    1998
    21
    1282
    7
    PubMed
    CrossRef
    PubMed
  17. Larme
    AC
    Pugh
    JA
    Attitudes of primary care providers toward diabetes: barriers to guideline implementation.
    Diabetes Care
    1998
    21
    1391
    6
    PubMed
    CrossRef
    PubMed
  18. Konen
    JC
    Curtis
    LG
    Summerson
    JH
    Symptoms and complications of adult diabetic patients in a family practice.
    Arch Fam Med
    1996
    5
    135
    45
    PubMed
    CrossRef
    PubMed
  19. Hiss
    RG
    Barriers to care in non–insulin-dependent diabetes mellitus. The Michigan experience.
    Ann Intern Med
    1996
    124
    146
    8
    CrossRef
    PubMed
  20. Hiss
    RG
    The concept of diabetes translation: addressing barriers to widespread adoption of new science into clinical care.
    Diabetes Care
    2001
    24
    1293
    6
    PubMed
    CrossRef
    PubMed
  21. Etzwiler
    DD
    Chronic care: a need in search of a system.
    Diabetes Educ
    1997
    23
    569
    73
    PubMed
    CrossRef
    PubMed
  22. Wagner
    EH
    Chronic disease management: what will it take to improve care for chronic illness? [Editorial]
    Eff Clin Pract
    1998
    1
    2
    4
    PubMed
    PubMed
  23. Adelman
    AM
    Harris
    R
    Improving performance in a primary care office.
    Clinical Diabetes
    1999
    16
    154
    60
  24. Dickey
    LL
    Kamerow
    DB
    Primary care physicians' use of office resources in the provision of preventive care.
    Arch Fam Med
    1996
    5
    399
    404
    PubMed
    CrossRef
    PubMed
  25. Helseth
    LD
    Susman
    JL
    Crabtree
    BF
    O'Connor
    PJ
    Primary care physicians' perceptions of diabetes management. A balancing act.
    J Fam Pract
    1999
    48
    37
    42
    PubMed
    PubMed
  26. Benjamin
    EM
    Schneider
    MS
    Hinchey
    KT
    Implementing practice guidelines for diabetes care using problem-based learning. A prospective controlled trial using firm systems.
    Diabetes Care
    1999
    22
    1672
    8
    PubMed
    CrossRef
    PubMed
  27. Lobach
    DF
    Hammond
    WE
    Computerized decision support based on a clinical practice guideline improves compliance with care standards.
    Am J Med
    1997
    102
    89
    98
    PubMed
    CrossRef
    PubMed
  28. Mazze
    RS
    Etzwiler
    DD
    Strock
    E
    Peterson
    K
    McClave
    CR
    2nd
    Meszaros
    JF
    et al
    Staged diabetes management. Toward an integrated model of diabetes care.
    Diabetes Care
    1994
    17
    56
    66
    PubMed
    PubMed
  29. Davis
    DA
    Taylor-Vaisey
    A
    Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines.
    CMAJ
    1997
    157
    408
    16
    PubMed
    PubMed
  30. Feder
    G
    Griffiths
    C
    Highton
    C
    Eldridge
    S
    Spence
    M
    Southgate
    L
    Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? A randomised controlled trial in general practices in east London.
    BMJ
    1995
    311
    1473
    8
    PubMed
    CrossRef
    PubMed
  31. Grol
    R
    Successes and failures in the implementation of evidence-based guidelines for clinical practice.
    Med Care
    2001
    39
    II46
    54
    PubMed
    CrossRef
    PubMed
  32. Lomas
    J
    Words without action? The production, dissemination, and impact of consensus recommendations.
    Annu Rev Public Health
    1991
    12
    41
    65
    PubMed
    CrossRef
    PubMed
  33. Anderson
    GM
    Lexchin
    J
    Strategies for improving prescribing practice.
    CMAJ
    1996
    154
    1013
    7
    PubMed
    PubMed
  34. Wensing
    M
    van der Weijden
    T
    Grol
    R
    Implementing guidelines and innovations in general practice: which interventions are effective?
    Br J Gen Pract
    1998
    48
    991
    7
    PubMed
    PubMed
  35. Pieber
    TR
    Holler
    A
    Siebenhofer
    A
    Brunner
    GA
    Semlitsch
    B
    Schattenberg
    S
    et al
    Evaluation of a structured teaching and treatment programme for type 2 diabetes in general practice in a rural area of Austria.
    Diabet Med
    1995
    12
    349
    54
    PubMed
    CrossRef
    PubMed
  36. Kinmonth
    AL
    Woodcock
    A
    Griffin
    S
    Spiegal
    N
    Campbell
    MJ
    Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk. The Diabetes Care From Diagnosis Research Team.
    BMJ
    1998
    317
    1202
    8
    PubMed
    CrossRef
    PubMed
  37. Fox
    CH
    Mahoney
    MC
    Improving diabetes preventive care in a family practice residency program: a case study in continuous quality improvement.
    Fam Med
    1998
    30
    441
    5
    PubMed
    PubMed
  38. O'Connor
    PJ
    Rush
    WA
    Peterson
    J
    Morben
    P
    Cherney
    L
    Keogh
    C
    et al
    Continuous quality improvement can improve glycemic control for HMO patients with diabetes.
    Arch Fam Med
    1996
    5
    502
    6
    PubMed
    CrossRef
    PubMed
  39. Sidorov
    J
    Gabbay
    R
    Harris
    R
    Shull
    RD
    Girolami
    S
    Tomcavage
    J
    et al
    Disease management for diabetes mellitus: impact on hemoglobin A1c.
    Am J Manag Care
    2000
    6
    1217
    26
    PubMed
    PubMed
  40. Sperl-Hillen
    J
    O'Connor
    PJ
    Carlson
    RR
    Lawson
    TB
    Halstenson
    C
    Crowson
    T
    et al
    Improving diabetes care in a large health care system: an enhanced primary care approach.
    Jt Comm J Qual Improv
    2000
    26
    615
    22
    PubMed
    PubMed
  41. Friedman
    NM
    Gleeson
    JM
    Kent
    MJ
    Foris
    M
    Rodriguez
    DJ
    Cypress
    M
    Management of diabetes mellitus in the Lovelace Health Systems' EPISODES OF CARE program.
    Eff Clin Pract
    1998
    1
    5
    11
    PubMed
    PubMed
  42. Rith-Najarian
    S
    Branchaud
    C
    Beaulieu
    O
    Gohdes
    D
    Simonson
    G
    Mazze
    R
    Reducing lower-extremity amputations due to diabetes. Application of the staged diabetes management approach in a primary care setting.
    J Fam Pract
    1998
    47
    127
    32
    PubMed
    PubMed
  43. Peters
    AL
    Legorreta
    AP
    Ossorio
    RC
    Davidson
    MB
    Quality of outpatient care provided to diabetic patients. A health maintenance organization experience.
    Diabetes Care
    1996
    19
    601
    6
    PubMed
    CrossRef
    PubMed
  44. Peters
    AL
    Davidson
    MB
    Application of a diabetes managed care program. The feasibility of using nurses and a computer system to provide effective care.
    Diabetes Care
    1998
    21
    1037
    43
    PubMed
    CrossRef
    PubMed
  45. Weinberger
    M
    Kirkman
    MS
    Samsa
    GP
    Shortliffe
    EA
    Landsman
    PB
    Cowper
    PA
    et al
    A nurse-coordinated intervention for primary care patients with non–insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life.
    J Gen Intern Med
    1995
    10
    59
    66
    PubMed
    CrossRef
    PubMed
  46. Integrated care for diabetes: clinical, psychosocial, and economic evaluation. Diabetes Integrated Care Evaluation Team.
    BMJ
    1994
    308
    1208
    12
    PubMed
    CrossRef
    PubMed
  47. Nilasena
    DS
    Lincoln
    MJ
    A computer-generated reminder system improves physician compliance with diabetes preventive care guidelines.
    Proc Annu Symp Comput Appl Med Care
    1995
    640
    5
    PubMed
  48. Aubert
    RE
    Herman
    WH
    Waters
    J
    Moore
    W
    Sutton
    D
    Peterson
    BL
    et al
    Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized, controlled trial.
    Ann Intern Med
    1998
    129
    605
    12
    CrossRef
    PubMed
  49. Halbert
    RJ
    Leung
    KM
    Nichol
    JM
    Legorreta
    AP
    Effect of multiple patient reminders in improving diabetic retinopathy screening. A randomized trial.
    Diabetes Care
    1999
    22
    752
    5
    PubMed
    CrossRef
    PubMed
  50. Farmer
    A
    Coulter
    A
    Organization of care for diabetic patients in general practice: influence on hospital admissions.
    Br J Gen Pract
    1990
    40
    56
    8
    PubMed
    PubMed
  51. Koperski
    M
    How effective is systematic care of diabetic patients? A study in one general practice.
    Br J Gen Pract
    1992
    42
    508
    11
    PubMed
    PubMed
  52. Branger
    PJ
    van't
    Hooft
    A
    van der Wouden
    JC
    Moorman
    PW
    van Bemmel
    JH
    Shared care for diabetes: supporting communication between primary and secondary care.
    Int J Med Inf
    1999
    53
    133
    42
    PubMed
    CrossRef
  53. Ornstein
    SM
    Jenkins
    RG
    MacFarlane
    L
    Glaser
    A
    Snyder
    K
    Gundrum
    T
    Electronic medical records as tools for quality improvement in ambulatory practice: theory and a case study.
    Top Health Inf Manage
    1998
    19
    35
    43
    PubMed
    PubMed
  54. Kleschen
    MZ
    Holbrook
    J
    Rothbaum
    AK
    Stringer
    RA
    McInerney
    MJ
    Helgerson
    SD
    Improving the pneumococcal immunization rate for patients with diabetes in a managed care population: a simple intervention with a rapid effect.
    Jt Comm J Qual Improv
    2000
    26
    538
    46
    PubMed
    PubMed
  55. Latessa
    RA
    Cummings
    DM
    Lilley
    SH
    Morrissey
    SL
    Changing practices in the use of pneumococcal vaccine.
    Fam Med
    2000
    32
    196
    200
    PubMed
    PubMed
  56. Litzelman
    DK
    Slemenda
    CW
    Langefeld
    CD
    Hays
    LM
    Welch
    MA
    Bild
    DE
    et al
    Reduction of lower extremity clinical abnormalities in patients with non–insulin-dependent diabetes mellitus. A randomized, controlled trial.
    Ann Intern Med
    1993
    119
    36
    41
    CrossRef
    PubMed
  57. Greenfield
    S
    Kaplan
    SH
    Ware
    JE
    Jr
    Yano
    EM
    Frank
    HJ
    Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes.
    J Gen Intern Med
    1988
    3
    448
    57
    PubMed
    CrossRef
    PubMed
  58. Anderson
    RM
    Funnell
    MM
    Butler
    PM
    Arnold
    MS
    Fitzgerald
    JT
    Feste
    CC
    Patient empowerment. Results of a randomized, controlled trial.
    Diabetes Care
    1995
    18
    943
    9
    PubMed
    CrossRef
    PubMed
  59. Hurwitz
    B
    Goodman
    C
    Yudkin
    J
    Prompting the clinical care of non-insulin dependent (type II) diabetic patients in an inner city area: one model of community care.
    BMJ
    1993
    306
    624
    30
    PubMed
    CrossRef
    PubMed
  60. Glasgow
    RE
    Toobert
    DJ
    Hampson
    SE
    Brown
    JE
    Lewinsohn
    PM
    Donnelly
    J
    Improving self-care among older patients with type II diabetes: the “Sixty Something” Study.
    Patient Educ Couns
    1992
    19
    61
    74
    PubMed
    CrossRef
    PubMed
  61. Glasgow
    RE
    La Chance
    PA
    Toobert
    DJ
    Brown
    J
    Hampson
    SE
    Riddle
    MC
    Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office.
    Patient Educ Couns
    1997
    32
    175
    84
    PubMed
    CrossRef
    PubMed
  62. Gruesser
    M
    Bott
    U
    Ellermann
    P
    Kronsbein
    P
    Joergens
    V
    Evaluation of a structured treatment and teaching program for non-insulin-treated type II diabetic outpatients in Germany after the nationwide introduction of reimbursement policy for physicians.
    Diabetes Care
    1993
    16
    1268
    75
    PubMed
    CrossRef
    PubMed
  63. Vinicor
    F
    Cohen
    SJ
    Mazzuca
    SA
    Moorman
    N
    Wheeler
    M
    Kuebler
    T
    et al
    DIABEDS: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes.
    J Chronic Dis
    1987
    40
    345
    56
    PubMed
    CrossRef
    PubMed
  64. Gaede
    P
    Vedel
    P
    Larsen
    N
    Jensen
    GV
    Parving
    HH
    Pedersen
    O
    Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
    N Engl J Med
    2003
    348
    383
    93
    PubMed
    CrossRef
    PubMed
  65. Jha
    AK
    Perlin
    JB
    Kizer
    KW
    Dudley
    RA
    Effect of the transformation of the Veterans Affairs Health Care System on the quality of care.
    N Engl J Med
    2003
    348
    2218
    27
    PubMed
    CrossRef
    PubMed
  66. Renders
    CM
    Valk
    GD
    Griffin
    SJ
    Wagner
    EH
    Eijk Van JT
    Assendelft
    WJ
    Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review.
    Diabetes Care
    2001
    24
    1821
    33
    PubMed
    CrossRef
    PubMed
  67. Institute of Medicine
    Crossing the Quality Chasm: A New Health System for the 21st Century.
    Washington, DC
    National Academy Pr
    2001
  68. Plsek
    PE
    Greenhalgh
    T
    Complexity science: The challenge of complexity in health care.
    BMJ
    2001
    323
    625
    8
    PubMed
    CrossRef
    PubMed
  69. Fraser
    SW
    Greenhalgh
    T
    Coping with complexity: educating for capability.
    BMJ
    2001
    323
    799
    803
    PubMed
    CrossRef
    PubMed
  70. Plsek
    PE
    Wilson
    T
    Complexity, leadership, and management in healthcare organisations.
    BMJ
    2001
    323
    746
    9
    PubMed
    CrossRef
    PubMed
  71. Wilson
    T
    Holt
    T
    Greenhalgh
    T
    Complexity science: complexity and clinical care.
    BMJ
    2001
    323
    685
    8
    PubMed
    CrossRef
    PubMed
Figure.

Translation research in the context of other types of research and public health assessments.

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Venkat Narayan KM, Benjamin E, Gregg EW, Norris SL, Engelgau MM. Diabetes Translation Research: Where Are We and Where Do We Want To Be?. Ann Intern Med. 2004;140:958–963. doi: 10.7326/0003-4819-140-11-200406010-00037

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Published: Ann Intern Med. 2004;140(11):958-963.

DOI: 10.7326/0003-4819-140-11-200406010-00037

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