Improving Diabetes Care:Effectiveness of Physician Profiling and Care Coordination by a Diabetes Resource Nurse

Baylor Scott and White Health (BSWH)

Status: Completed

Conditions: Diabetes Mellitus

Treatments: Other: Medicare Claims Feedback; Other: Diabetes Resource Nurse; Other: Medical Record Review

Study type: Interventional

Funder types: Other

Identifiers

NCT00258674

000-113

Details and patient eligibility

About

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.

Full 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.

Enrollment: 1,891 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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1,891 participants in 3 patient groups

Medicare Claims Feedback

Active Comparator group

Description:

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.

Treatment:

Other: Medicare Claims Feedback

Medicare Claims+Medical Record Feedback

Experimental group

Description:

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.

Treatment:

Other: Medical Record Review

Other: Medicare Claims Feedback

Medicare Claims+Medical Chart Review+DRN

Experimental group

Description:

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.

Treatment:

Other: Diabetes Resource Nurse

Other: Medical Record Review

Other: Medicare Claims Feedback