- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00258674
Improving Diabetes Care:Effectiveness of Physician Profiling and Care Coordination by a Diabetes Resource Nurse
June 9, 2017 updated by: Baylor Research Institute
A Randomized Trial of Strategies to Improve Diabetes Care: Effectiveness and Costs of Physician Profiling and Care Coordination by a Diabetes Resource Nurse
The purpose of this study is to test the effectiveness of physician profiling and care coordination by a diabetes resource nurse in improving the quality of diabetes care.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
HealthTexas Provider Network primary care practices with at least 10 Medicare diabetes patients over the age of 65 were randomized to one of 3 intervention arms: physician feedback of process measures using Medicare claims data ("Claims"); feedback of Medicare claims data plus clinical measures from medical record abstraction ("Claims+MR"); or both types of feedback plus a practice-based DRN ("DRN").
For the 12 months prior to the intervention and 12 months post-intervention, performance data on diabetes related processes of care (annual HbA1c testing, annual LDL cholesterol screening, annual hypertension screening, annual eye, foot, and renal assessment) and patient outcomes (HbA1c level, LDL cholesterol level, blood pressure) were collected from medical record abstraction and Medicare claims data.
Pre-post change scores will be compared between intervention arms to examine effectiveness of physician profiling and care coordination by a diabetes resource nurse.
Study Type
Interventional
Enrollment (Actual)
1891
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Texas
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Dallas, Texas, United States, 75206
- Baylor Health Care System Institute for Health Care Research and Improvement
-
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
65 years and older (Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- age ≥ 65 years on January 1, 2000
- diagnosis of diabetes mellitus
- diabetes related visit to HTPN physician within the past year
- Resident of Texas
- Medicare insurance coverage
Exclusion Criteria:
- Patient chart not available for abstraction
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Medicare Claims Feedback
Practices randomised to the Medicare Claims Feedback arm received period feedback on their performance on selected diabetes quality of care measures as reflected in the claims data for their diabetes patients.
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Physician practices received periodic feedback on their performance on selected diabetes quality of care measures as reflected by the Medicare claims data for their patients.
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Experimental: Medicare Claims+Medical Record Feedback
Practices randomised to the Medicare Claims + Medical Record Review Feedback arm received periodic feedback on their performance on selected diabetes quality of care measures as reflected in both the Medicare claims for the diabetes patients AND review/audit of their diabetes patients' medical records.
|
Physician practices received periodic feedback on their performance on selected diabetes quality of care measures as reflected by the Medicare claims data for their patients.
Physician practices received period feedback on their performance on selected diabetes quality of care measures, as reflected by data collected from their patients' medical records.
These data were compiled by trained nurse abstractors using a standardized data collection tool developed for this study.
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Experimental: Medicare Claims+Medical Chart Review+DRN
In addition to the performance data from both Medicare Claims data and from review of patients' medical records, practices randomised to the Medicare Claims + Medical Record review + Diabetes Resource Nurse (DRN) had a diabetes resource nurse assigned to them, who was available to provide diabetes education and care-coordination type services for their diabetes patients.
|
Physician practices received periodic feedback on their performance on selected diabetes quality of care measures as reflected by the Medicare claims data for their patients.
Physician practices received period feedback on their performance on selected diabetes quality of care measures, as reflected by data collected from their patients' medical records.
These data were compiled by trained nurse abstractors using a standardized data collection tool developed for this study.
Diabetes Resource Nurses (DRNs) were registered nurses with 3-5 years of experience as certified diabetes educations who performed initial patient assessments, developed plans of care, administered screening tools, and monitored clinical outcomes.
Physicians at the practices randomised to this intervention had could access the DRN's services for their diabetes patients, but neither physicians nor patients had to take advantage of this resource.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change Score for "HbA1c <9 Percent"
Time Frame: This measure compared baseline values (01/01/2000-12/31/2000) to follow-up values (01/01/2001-12/31/2001)
|
Each patient was assigned a "change score" of -1, 0, or 1.
A positive value indicated a patient non-adherent to the guideline recommendation for HbA1c <9 percent at baseline had achieved such a level at follow up.
Patient-level change scores were then summed and averaged over each study arm.
|
This measure compared baseline values (01/01/2000-12/31/2000) to follow-up values (01/01/2001-12/31/2001)
|
Change Score for "LDL <100 mg/dL"
Time Frame: change from baseline (01/01/2000-12/31/2000) to follow-up (01/01/2001-12/31/2001)
|
Each patient was assigned a "change score" of -1, 0, or 1.
A positive value indicated that a patient non-adherent to the guideline recommendation of LDL <100 mg/dL at baseline had achieved adherence at follow-up.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (01/01/2000-12/31/2000) to follow-up (01/01/2001-12/31/2001)
|
Change Score for "Blood Pressure (b.p.) <130/80 mmHg"
Time Frame: change from baseline (01/01/2000-12/31/2000) to follow-up (01/01/200112/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated that a patient non-adherent to the guideline recommendation of blood pressure <130/80 mmHg at baseline had achieved adherence at follow-up.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (01/01/2000-12/31/2000) to follow-up (01/01/200112/31/2001)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change Score for "HbA1c Level"
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change score was calculated by subtracting the follow-up HbA1c value from the baseline value for each patient.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Diastolic Blood Pressure"
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change score was calculated by subtracting the follow-up value from the baseline value for each patient.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "LDL Level"
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change score was calculated by subtracting the follow-up LDL value from the baseline value for each patient.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Systolic Blood Pressure"
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change score was calculated by subtracting the follow-up value from the baseline value for each patient.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual HbA1c Assessment" (as Determined From Medical Record Review)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual HbA1c assessment in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual Lipid Assessment" (as Determined From Medical Record Review)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual lipid assessment in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual Blood Pressure Assessment" (as Determined From Medical Record Review)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual blood pressure assessment in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual Foot Exam" (as Determined by Medical Record Review)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual foot exam in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual Eye Exam" (as Determined From Medical Record Review)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual eye exam in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual Renal Function Assessment" (as Determined From Medical Record Review)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual renal function assessment in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual HbA1c Assessment" (as Determined From Medicare Claims Data)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual HbA1c assessment in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual Eye Exam" (as Determined From Medicare Claims Data)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual eye exam in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Annual Lipid Assessment" (as Determined From Medicare Claims Data)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for an annual lipid assessment in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Change Score for "Semiannual HbA1c Assessment" (as Determined From Medicare Claims Data)
Time Frame: change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Each patient was assigned a change score of -1, 0, or 1.
A positive value indicated a patient who was non-compliant with the guideline recommendation for a semi-annual HbA1c assessment in the baseline period was compliant in the follow-up period.
Patients missing either a baseline or follow-up value were excluded.
Patient-level change scores were then summed and averaged over each study arm.
|
change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: David J Ballard, MD,MSPH,PhD, Baylor Health Care System Institute for Health Care Research and Improvement
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Hollander P, Nicewander D, Couch C, Winter D, Herrin J, Haydar Z, Ballard DJ. Quality of care of Medicare patients with diabetes in a metropolitan fee-for-service primary care integrated delivery system. Am J Med Qual. 2005 Nov-Dec;20(6):344-52. doi: 10.1177/1062860605280205.
- Herrin J, Nicewander DA, Hollander PA, Couch CE, Winter FD, Haydar ZR, Warren SS, Ballard DJ. Effectiveness of diabetes resource nurse case management and physician profiling in a fee-for-service setting: a cluster randomized trial. Proc (Bayl Univ Med Cent). 2006 Apr;19(2):95-102. doi: 10.1080/08998280.2006.11928137.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
January 1, 2000
Primary Completion (Actual)
December 1, 2001
Study Completion (Actual)
December 1, 2001
Study Registration Dates
First Submitted
November 23, 2005
First Submitted That Met QC Criteria
November 23, 2005
First Posted (Estimate)
November 28, 2005
Study Record Updates
Last Update Posted (Actual)
June 14, 2017
Last Update Submitted That Met QC Criteria
June 9, 2017
Last Verified
June 1, 2017
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 000-113
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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