Cited by 110Diabetes Management and EducationPrimary Care and Health OutcomesDiabetes Treatment and Management

An Intervention to Overcome Clinical Inertia and Improve Diabetes Mellitus Control in a Primary Care Setting: Improving Primary Care of African Americans With Diabetes (IPCAAD) 8

Ziemer, David C., Doyle, Joyce P., Barnes, Catherine S., Branch, William T., Cook, Curtiss B., El-Kebbi, Imad M., Gallina, Daniel L., Kolm, Paul +2 more·2006·Archives of Internal Medicine

Abstract

BACKGROUND: Although clinical trials have shown that proper management of diabetes can improve outcomes, and treatment guidelines are widespread, glycated hemoglobin (HbA1c) levels in the United States are rising. Since process measures are improving, poor glycemic control may reflect the failure of health care providers to intensify diabetes therapy when indicated--clinical inertia. We asked whether interventions aimed at health care provider behavior could overcome this barrier and improve glycemic control. METHODS: In a 3-year trial, 345 internal medicine residents were randomized to be controls or to receive computerized reminders providing patient-specific recommendations at each visit and/or feedback on performance every 2 weeks. When glucose levels exceeded 150 mg/dL (8.33 mmol/L) during visits of 4038 patients, health care provider behavior was characterized as did nothing, did anything (any intensification of therapy), or did enough (if intensification met recommendations). RESULTS: At baseline, residents did anything for 35% of visits and did enough for 21% of visits when changes in therapy were indicated, and there were no differences among intervention groups. During the trial, intensification increased most during the first year and then declined. However, intensification increased more in the feedback alone and feedback plus reminders groups than for reminders alone and control groups (P<.001). After 3 years, health care provider behavior in the reminders alone and control groups returned to baseline, whereas improvement with feedback alone and feedback plus reminders groups was sustained: 52% did anything, and 30% did enough (P<.001 for both vs the reminders alone and control groups). Multivariable analysis showed that feedback on performance contributed independently to intensification and that intensification contributed independently to fall in HbA1c (P<.001 for both). CONCLUSIONS: Feedback on performance given to medical resident primary care providers improved provider behavior and lowered HbA1c levels. Similar approaches may aid health care provider behavior and improve diabetes outcomes in other primary care settings.

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Crossref · 10.1001/archinte.166.5.507

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  • Ziemer 2006 found that the combination of reminders and feedback had a greater effect on treatment intensification than feedback alone (adjusted RD = 7.25%; no P value reported).

    “Ziemer 2006 assessed clinical inertia in diabetes and found that the combination of reminders and feedback had a greater effect on treatment intensification than feedback alone (adjusted RD = 7.25%; no P value reported).”

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Authors
Ziemer, D. C., Doyle, J. P., Barnes, C. S., Branch, W. T., Cook, C. B., El-Kebbi, I. M., Gallina, D. L., Kolm, P., Rhee, M. K., & Phillips, L. S.
Affiliations
  • Grady Memorial Hospital (US)
  • Emory University (US)
Venue
Archives of Internal Medicine
Published
2006-03-13
Volume
166
Issue
5
Pages
507
ISSN
0003-9926 (ISSN-L)
OpenAlex
W2082548673
Cited by
110
References
41
Citations by year
2025: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 6 · 2019: 2 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 7 · 2014: 3 · 2013: 7 · 2012: 9
FWCI
7.50
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Agency for Healthcare Research and Quality (HS 07922)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK0-66204, DK062668, DK07298, F32DK062668, R18DK066204)
  • National Center for Research Resources (RR00039, RR017643, K12RR017643)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
clinical inertia, diabetes mellitus, glycemic control, HbA1c, computerized reminders, performance feedback, internal medicine residents, primary care, provider behavior
MeSH terms
Adult, Black or African American, Clinical Competence, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Health Personnel, Humans, Internship and Residency, Male, Middle Aged, Patient Care Team, Physician-Patient Relations, Primary Health Care, Quality Assurance, Health Care, Retrospective Studies, United States

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