Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes
Female; Humans; Male; Adult; Prospective Studies; Middle Aged; Outcome Assessment (Health Care); Primary Health Care; Diabetes Mellitus; Continuity of Patient Care; Health Behavior; Self Care; Type 2/psychology; Type 2/therapy
BACKGROUND: The influence of continuity of care on outcomes of care for patients with type 2 diabetes is poorly understood. OBJECTIVE: To examine the relationships between continuity, glucose control, and advancement through stages of change for self-management behaviors. DESIGN: Prospective cohort study. SETTING: Five community health centers on the Texas-Mexico border. SUBJECTS: A random sample of 256 adults, 18 years of age and older with an established diagnosis of type 2 diabetes. MEASURES: Stage of change for diet and exercise were assessed during two patient interviews, averaging 18.9 months apart. Phlebotomy was performed at each interview to measure glycosolated hemoglobin (HbA1C). Medical records were abstracted for ambulatory care utilization. A continuity score was calculated based on the number of visits and number of providers seen. RESULTS: Patients who advanced one or more stages of change for diet had higher levels of continuity. As continuity improved, the change in HbA1C was smaller. (r = -0.25; P <0.001) This relationship remained significant after controlling for number of visits, months since diagnosis, number of days in the study, duration of diabetes, and advancement in stage of change for diet. Advancement through stage of change for diet explained a significant amount of the variance in the relationship between continuity and HbA1C (t test = -11.33; P <0.01). CONCLUSIONS: Continuity of care with a primary care provider is associated with better glucose control among patients with type 2 diabetes. This relationship appears to be mediated by changes in patient behavior regarding diet.
2002
Parchman M; Pugh J; Noel PH; Larme A
Medical Care
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00005650-200202000-00008" target="_blank" rel="noreferrer">10.1097/00005650-200202000-00008</a>
Building measurement and data collection into medical practice
Humans; Data Collection; Physician's Role; Clinical Protocols; Outcome and Process Assessment (Health Care); patient care team; RDF Project; Diabetes Mellitus; Cost Control; Practice Management; Medical/standards; Blood Glucose Self-Monitoring; Type 2/therapy; Urinary Tract Infections/therapy
Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measurement; 2) use a balanced set of process, outcome, and cost measures; 3) keep measurement simple (think big, but start small); 4) use qualitative and quantitative data; 5) write down the operational definitions of measures; 6) measure small, representative samples; 7) build measurement into daily work; and 8) develop a measurement team. The following approaches to using data for improvement are recommended. First, begin with curiosity about outcomes or a need to improve results. Second, try to avoid knee-jerk, obstructive criticism of proposed measurements. Instead, propose solutions that are practical, goal-oriented, and good enough to start with. Third, gather baseline data on a small sample and check the findings. Fourth, try to change and improve the delivery process while gathering data. Fifth, plot results over time and analyze them by using a control chart or other graphical method. Sixth, refine your understanding of variation in processes and outcomes by dividing patients into clinically homogeneous subgroups (stratification) and analyzing the results separately for each subgroup. Finally, make further changes while measuring key outcomes over time. Measurement and improvement are intertwined; it is impossible to make improvements without measurement. Measuring and learning from each patient and using the information gleaned to test improvements can become part of daily medical practice in local settings.
1998
Nelson EC; Splaine ME; Batalden PB; Plume SK
Annals Of Internal Medicine
1998
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.7326/0003-4819-128-6-199803150-00007" target="_blank" rel="noreferrer">10.7326/0003-4819-128-6-199803150-00007</a>