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

NCT00258674 | Completed Results DMC

• 1 other identifier: 000-113
• Study Type: interventional
• Target: 1,891
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Diabetes Mellitus

Keywords

Diabetes; Care coordination; Case management; Physician profiling

Outcome Measures

Primary Outcomes (3)

• Change Score for "HbA1c <9 Percent"

  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"

  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"

  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 Outcomes (14)

• Change Score for "HbA1c Level"

  change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)

• Change Score for "Diastolic Blood Pressure"

  change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)

• Change Score for "LDL Level"

  change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)

• Change Score for "Systolic Blood Pressure"

  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)

  change from baseline (1/1/2000-12/31/2000) to follow-up (1/1/2001-12/31/2001)

Study Arms (3)

Medicare Claims Feedback

ACTIVE COMPARATOR

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.

Other: Medicare Claims Feedback

Medicare Claims+Medical Record Feedback

EXPERIMENTAL

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.

Other: Medicare Claims Feedback; Other: Medical Record Review

Medicare Claims+Medical Chart Review+DRN

EXPERIMENTAL

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.

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

Interventions

Medical Record Review OTHER

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.

Medicare Claims+Medical Chart Review+DRN; Medicare Claims+Medical Record Feedback

Diabetes Resource Nurse OTHER

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.

Medicare Claims+Medical Chart Review+DRN

Medicare Claims Feedback OTHER

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.

Medicare Claims Feedback; Medicare Claims+Medical Chart Review+DRN; Medicare Claims+Medical Record Feedback

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• Patient chart not available for abstraction

Sponsors & Collaborators

• American Diabetes Association: collaborator
• Baylor Research Institute: lead

Study Sites (1)

Baylor Health Care System Institute for Health Care Research and Improvement

Dallas, Texas, 75206, United States

Location

Related Publications (2)

• 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.

  PMID: 16280398 RESULT

• 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.

  PMID: 16609732 RESULT

MeSH Terms

Conditions

Diabetes Mellitus

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases

Limitations and Caveats

All participating practices belonged to the same network of fee-for-service practices, which may reduce generalizability. Neither physicians nor patients could be blinded; but data were collected by individuals blinded to study arm assignments.

Results Point of Contact

• Title: Baylor Research Institute
• Organization: Baylor Research Institute

Elizabeth.Cothran@baylorhealth.edu

214-820-9991

Study Officials

• David J Ballard, MD,MSPH,PhD

  Baylor Health Care System Institute for Health Care Research and Improvement

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 23, 2005
• First Posted: November 28, 2005
• Study Start: January 1, 2000
• Primary Completion: December 1, 2001
• Study Completion: December 1, 2001
• Last Updated: March 3, 2026
• Results First Posted: October 23, 2012

Record last verified: 2026-02

Locations

US (1)