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Simulated physician learning program improves glucose control in adults with diabetes.

Sperl-Hillen JM, O'Connor PJ, Rush WA, Johnson PE, Gilmer T, Biltz G, Asche SE, Ekstrom HL - Diabetes Care (2010)

Bottom Line: Intervention clinic patients with baseline A1C >or=7% significantly improved glycemic control at the last postintervention A1C measurement, intervention effect of -0.19% mean A1C (P = 0.034) and +6.7% in A1C <7% goal achievement (P = 0.0099).The intervention did not significantly improve blood pressure or LDL control.Models adjusting for age, sex, and comorbidity showed similar results.

View Article: PubMed Central - PubMed

Affiliation: HealthPartners Research Foundation and HealthPartners Medical Group, Minneapolis, Minnesota, USA. joann.m.sperlhillen@healthpartners.com

ABSTRACT

Objective: Inexpensive and standardized methods to deliver medical education to primary care physicians (PCPs) are desirable. Our objective was to assess the impact of an individualized simulated learning intervention on diabetes care provided by PCPs.

Research design and methods: Eleven clinics with 41 consenting PCPs in a Minnesota medical group were randomized to receive or not receive the learning intervention. Each intervention PCP was assigned 12 simulated type 2 diabetes cases that took about 15 min each to complete. Cases were designed to remedy specific physician deficits found in their electronic medical record observed practice patterns. General linear mixed models that accommodated the cluster randomized study design were used to assess patient-level change from preintervention to 12-month postintervention of A1C, blood pressure, and LDL cholesterol. The relationship between the study arm and the total of intervention and patient health care costs was also analyzed.

Results: Intervention clinic patients with baseline A1C >or=7% significantly improved glycemic control at the last postintervention A1C measurement, intervention effect of -0.19% mean A1C (P = 0.034) and +6.7% in A1C <7% goal achievement (P = 0.0099). Costs trended lower, with the cost per patient -$71 (SE = 142, P = 0.63) relative to nonintervention clinic patients. The intervention did not significantly improve blood pressure or LDL control. Models adjusting for age, sex, and comorbidity showed similar results. PCPs reported high satisfaction.

Conclusions: A brief individualized case-based simulated learning intervention for PCPs led to modest but significant glucose control improvement in adults with type 2 diabetes without increasing costs.

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Related in: MedlinePlus

Diagram illustrating allocation of clinics, PCPs, and diabetes patients to the two study arms. The diagram also shows the disposition of diabetes patients who were and were not included in the analysis. *Eligible PCPs worked >60% of a full time equivalent and had ≥10 patients with diabetes. **Patients were linked to the study-consented last-assigned PCP during the preintervention period and study-consented first-assigned PCP during the postintervention period. Patients lacking an assigned PCP were linked to the provider seen most during the study period. PCP, primary care physician.
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Figure 1: Diagram illustrating allocation of clinics, PCPs, and diabetes patients to the two study arms. The diagram also shows the disposition of diabetes patients who were and were not included in the analysis. *Eligible PCPs worked >60% of a full time equivalent and had ≥10 patients with diabetes. **Patients were linked to the study-consented last-assigned PCP during the preintervention period and study-consented first-assigned PCP during the postintervention period. Patients lacking an assigned PCP were linked to the provider seen most during the study period. PCP, primary care physician.

Mentions: PCPs were eligible for the study if they practiced in one of the study clinics, provided care to at least 10 adult patients with diabetes, and signed a consent form. Patients were classified as having diabetes if they had two or more outpatient diabetes ICD-9 codes or used a diabetes-specific medication in the year before randomization (see Fig. 1 for the detailed consort description).


Simulated physician learning program improves glucose control in adults with diabetes.

Sperl-Hillen JM, O'Connor PJ, Rush WA, Johnson PE, Gilmer T, Biltz G, Asche SE, Ekstrom HL - Diabetes Care (2010)

Diagram illustrating allocation of clinics, PCPs, and diabetes patients to the two study arms. The diagram also shows the disposition of diabetes patients who were and were not included in the analysis. *Eligible PCPs worked >60% of a full time equivalent and had ≥10 patients with diabetes. **Patients were linked to the study-consented last-assigned PCP during the preintervention period and study-consented first-assigned PCP during the postintervention period. Patients lacking an assigned PCP were linked to the provider seen most during the study period. PCP, primary care physician.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2909050&req=5

Figure 1: Diagram illustrating allocation of clinics, PCPs, and diabetes patients to the two study arms. The diagram also shows the disposition of diabetes patients who were and were not included in the analysis. *Eligible PCPs worked >60% of a full time equivalent and had ≥10 patients with diabetes. **Patients were linked to the study-consented last-assigned PCP during the preintervention period and study-consented first-assigned PCP during the postintervention period. Patients lacking an assigned PCP were linked to the provider seen most during the study period. PCP, primary care physician.
Mentions: PCPs were eligible for the study if they practiced in one of the study clinics, provided care to at least 10 adult patients with diabetes, and signed a consent form. Patients were classified as having diabetes if they had two or more outpatient diabetes ICD-9 codes or used a diabetes-specific medication in the year before randomization (see Fig. 1 for the detailed consort description).

Bottom Line: Intervention clinic patients with baseline A1C >or=7% significantly improved glycemic control at the last postintervention A1C measurement, intervention effect of -0.19% mean A1C (P = 0.034) and +6.7% in A1C <7% goal achievement (P = 0.0099).The intervention did not significantly improve blood pressure or LDL control.Models adjusting for age, sex, and comorbidity showed similar results.

View Article: PubMed Central - PubMed

Affiliation: HealthPartners Research Foundation and HealthPartners Medical Group, Minneapolis, Minnesota, USA. joann.m.sperlhillen@healthpartners.com

ABSTRACT

Objective: Inexpensive and standardized methods to deliver medical education to primary care physicians (PCPs) are desirable. Our objective was to assess the impact of an individualized simulated learning intervention on diabetes care provided by PCPs.

Research design and methods: Eleven clinics with 41 consenting PCPs in a Minnesota medical group were randomized to receive or not receive the learning intervention. Each intervention PCP was assigned 12 simulated type 2 diabetes cases that took about 15 min each to complete. Cases were designed to remedy specific physician deficits found in their electronic medical record observed practice patterns. General linear mixed models that accommodated the cluster randomized study design were used to assess patient-level change from preintervention to 12-month postintervention of A1C, blood pressure, and LDL cholesterol. The relationship between the study arm and the total of intervention and patient health care costs was also analyzed.

Results: Intervention clinic patients with baseline A1C >or=7% significantly improved glycemic control at the last postintervention A1C measurement, intervention effect of -0.19% mean A1C (P = 0.034) and +6.7% in A1C <7% goal achievement (P = 0.0099). Costs trended lower, with the cost per patient -$71 (SE = 142, P = 0.63) relative to nonintervention clinic patients. The intervention did not significantly improve blood pressure or LDL control. Models adjusting for age, sex, and comorbidity showed similar results. PCPs reported high satisfaction.

Conclusions: A brief individualized case-based simulated learning intervention for PCPs led to modest but significant glucose control improvement in adults with type 2 diabetes without increasing costs.

Show MeSH
Related in: MedlinePlus