Research article summary (published 29 Jun 2008):

Chronic care model and shared care in diabetes: randomized trial of an electronic decision support system.

Full Abstract

OBJECTIVE:
To assess the effect of a specialist telemedicine intervention for improving diabetes care using the chronic care model (CCM).

PARTICIPANTS AND METHODS:
As part of the CCM, 97 primary care physicians at 6 primary care practices in Rochester, MN, referred 639 patients to an on-site diabetes educator between July 1, 2001, and December 31, 2003. On first referral, physicians were centrally randomized to receive a telemedicine intervention (specialty advice and evidence-based messages regarding medication management for cardiovascular risk) or no intervention, keeping outcome assessors and data analysts blinded to group assignment. After each subsequent clinical encounter, endocrinologists reviewed an abstract from the patient's electronic medical record and provided management recommendations and supporting evidence to intervention physicians via e-mail. Control physicians received e-mail with periodic generic information about cardiovascular risk reduction in diabetes. Outcome measures included diabetes care processes (diabetes test completion), outcomes (metabolic and cardiovascular risk factors, estimated coronary artery disease risk), and patient costs (payer perspective).

RESULTS:
During the intervention, 951 (70%) of the 1361 endocrinology reviews detected performance gaps and resulted in a message; primary care physicians reported using 49% of messages in patient care. With a mean of 21 months' follow-up, the intervention, compared with control, did not significantly enhance metabolic outcomes or reduce estimated risk of coronary artery disease (adjusted mean difference, -1%; 95% confidence interval, -19% to 17%). The intervention group incurred lower costs (P=.02) but not in diabetes-related costs.

CONCLUSION:
Specialty telemedicine did not significantly enhance the value of CCM in primary care.

Learn Faster Today      Improve your study skills

Author information

Author/s: Smith, Steven A (SA); Shah, Nilay D (ND); Bryant, Sandra C (SC); Christianson, Teresa J H (TJ); Bjornsen, Susan S (SS); Giesler, Paula D (PD); Krause, Kathleen (K); Erwin, Patricia J (PJ); Montori, Victor M (VM); Evidens Research Group;

Affiliation: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA. smith.steven(-atsign-)mayo.edu

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Journal: Mayo Clinic proceedings. Mayo Clinic (Mayo Clin Proc), published in United States. (Language: eng)

Reference: 2008-Jul; vol 83 (issue 7) : pp 747-57

Dates: Created 2008/07/10; Completed 2008/07/22; Revised 2008/10/21;

PMID: 18613991, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

ErratumIn: Mayo Clin Proc. 2008 Oct;83(10):1189.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent Adult Aged Aged, 80 and over Chronic Disease Clinical Competence Coronary Disease - epidemiology; etiology; prevention & control Cost-Benefit Analysis Decision Support Systems, Clinical - economics; instrumentation Diabetes Mellitus - blood; therapy Female Follow-Up Studies

Health Care Costs - statistics & numerical data Humans Male Middle Aged Morbidity - trends Physicians, Family - standards Primary Health Care - methods; standards Retrospective Studies Survival Rate - trends Telemedicine - methods Time Factors United States - epidemiology

Related articles

These are the highest related articles currently in the database:

• Diabetes decision support: initial experience with the Vermont diabetes information system. 26 Feb 2006
• A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes. 27 Feb 2006
• Electronic medical record-assisted design of a cluster-randomized trial to improve diabetes care and outcomes. 30 Mar 2008
• Are clinicians' information needs and decision support affected by different models of care? Experimental study. 30 Dec 2006
• Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice. 27 Feb 2005
• Brief report: Training internists in shared decision making about chronic opioid treatment for noncancer pain. 30 Mar 2006
• A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. 29 Mar 2005
• Deploying the chronic care model to implement and sustain diabetes self-management training programs. 27 Feb 2006
• Computed critiquing integrated into daily clinical practice affects physicians' behavior--a randomized clinical trial with AsthmaCritic. 30 Dec 2005
• Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care. 29 Sep 2006

See 100+ related articles.

Related Article Map

Legend: - FREE Full text Article. - Abstract only. - Title only. More help.

See a large map of 100+ related articles.