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Completed

NCT Number: NCT00258674

Improving Diabetes Care:Effectiveness 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.

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Key information

Conditions

Diabetes Mellitus Endocrine System Diseases Glucose Metabolism Disorders Metabolic Diseases Nutritional and Metabolic Diseases

Age range

65 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Baylor Health Care System Institute for Health Care Research and Improvement

Dallas, Texas, 75206, United States

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

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.

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.

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.

Primary outcomes

  1. 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.

  2. 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.

  3. 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.

Secondary outcomes

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

Sponsors and collaborators

Lead sponsor

Baylor Research Institute

Other

Collaborators

  • American Diabetes Association

Registry information

Official study title

A Randomized Trial of Strategies to Improve Diabetes Care: Effectiveness and Costs of Physician Profiling and Care Coordination by a Diabetes Resource Nurse

Important dates

Study start
2000
Primary completion
2001
Study completion
2001
First posted
Nov 28, 2005
Registry last updated
Mar 3, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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