A Study of the Effect of a Chronic Disease Management System on Diabetes Care Within Multidisciplinary Primary Care Practices in Ontario

Challenging the Ontario Diabetes Care Quality Gap: Evaluation and Long-Term Cost-Utility Analysis of Using a Chronic Disease Management System (CDMS) in Primary Health Care Practices in Ontario (ODIAC-CDMS): A Prospective, Observational, Comparative Study of the Effect of a CDMS on Diabetes Care Within Multidisciplinary Primary Care Practices in Ontario.

The purpose of this study is to evaluate the impact of using a web-based (P-PROMPT) chronic disease management system (CDMS) by primary care practitioners and their team members and on their care for patients with diabetes. The system will help to ensure that all patients have up-to-date laboratory monitoring and visits as recommended by the Canadian Diabetes Association Guidelines. The hypothesis is that the use of a CDMS in Ontario primary care practices, as a part of the routine clinical management of diabetes patients, can improve monitoring frequency of A1C, blood pressure (BP) and cholesterol levels. The results of this study will serve as a benchmark for the utilization of chronic disease management software tools in primary care diabetes management for patients in Ontario, establishing and providing evidence to inform decision-makers. If the results are favorable towards CDMS interventions for the management of diabetes, potential expansion and availability of these types of programs may be possible for other chronic diseases.

Study Overview

• Status: Completed
• Conditions: Diabetes
• Intervention / Treatment: Other: P-PROMPT

Detailed Description

Practice Guidelines recommend that patients with chronic diseases should be monitored with specified clinical measurements each with regular repeats at different specified time intervals or on specified conditions. It is virtually impossible for health care providers to adhere consistently to guidelines and to do so sustainability as well as equitably for "most if not all" of their patients with diabetes. Ontario Health Technology Advisory Committee (OHTAC) has requested the following study. Aggregate monthly primary care practice level data will form the basis of the analysis. Primary care practitioners in Ontario will be enrolled. Differences in 1-year outcome measures within will be performed. Baseline, 2 month, 6 month and 12 month site team member surveys will be completed. Using patient level data from each site, a cost-utility analysis will be conducted. Six aspects related to the use of the CDMS will be examined.

1. Change in proportion of the patients in whom monitoring frequency is up to date for A1C, blood pressure and cholesterol.
2. Change in proportion of patients who are well controlled with A1C < 0.07, blood pressure < 130/80 and LDL-cholesterol < 2.0.
3. Change from baseline across sites in the percentage of patients with an up-to-date foot exam, retinopathy screening, use of angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) and documentation of self-management goals.
4. Site questionnaires.
5. Changes in physician MOHLTC diabetes incentive billings.
6. Long-term cost-utility of the use of the CDMS.

• Study Type: Observational
• Enrollment (Actual): 39

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Brockcillw, Ontario, Canada, K6C 0A5
      • Brockville Family Health Team
    • Delhi, Ontario, Canada, N4B 2L8
      • Delhi Family Health Team
    • Etobicoke, Ontario, Canada, M9C 5N2
      • Summerville Family Health Team
    • Harrow, Ontario, Canada, N0R 1G0
      • Harrow Health Centre
    • Lemington, Ontario, Canada, N8H 1N9
      • Leamington and Area Family Health Team
    • Toronto, Ontario, Canada, M5A 2S5
      • Sherbourne Family Health Team

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The unit of evaluation or cluster for this study will be individual primary care practitioners. The study will analyze aggregate practice level data from all rostered diabetes patients within each practice. Between 33 and 61 primary care practitioners with a total number of patients with diabetes across all practices of 2,376 from across Ontario will be enrolled in the study.

Description

Inclusion Criteria:

• Ontario primary care practitioners able to provide a list of patients within their practice.
• High-speed internet access in the practice environment or willingness to obtain high-speed internet access.
• Physicians willing to use the CDMS or already using it currently.

Exclusion Criteria:

• Ontario primary care practitioners involved in the QIIP Learning Collaboratives who are practicing in one of the following local health integration networks:

  • LHIN 2 South West
  • LHIN 7 Toronto Central
  • LHIN 11 Champlain AND
  • LHIN 14 North West so as to not interfere with other Provincial diabetes initiatives.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in monitoring frequency	Change in proportion of patients, with up-to-date monitoring of A1C (6 months), blood pressure (annually) and cholesterol (6 months) in practices using a CDMS for 1 year	1 year

Collaborators and Investigators

• Sponsor: St. Joseph's Healthcare Hamilton
• Investigators: Principal Investigator: Ron Goeree, St. Joseph's Healthcare Hamilton/McMaster University

Study record dates

Study Major Dates

• Study Start: June 1, 2009
• Primary Completion (Actual): October 1, 2011
• Study Completion (Actual): March 1, 2012

Study Registration Dates

• First Submitted: June 4, 2009
• First Submitted That Met QC Criteria: June 4, 2009
• First Posted (Estimate): June 5, 2009

Study Record Updates

• Last Update Posted (Estimate): May 9, 2013
• Last Update Submitted That Met QC Criteria: May 7, 2013
• Last Verified: May 1, 2013

More Information

Terms related to this study

• Keywords: Diabetes
• Additional Relevant MeSH Terms: Pathologic Processes; Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Disease Attributes; Diabetes Mellitus; Chronic Disease
• Other Study ID Numbers: FEEAP-D0014a-2009-PTL