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Developing and Implementing a Quality Measure for Glycemic Control



Developing and Implementing a Quality Measure for Glycemic Control

For Condition: Diabetes
Status: No longer recruiting
Sponsor(s): Department of Veterans Affairs ,
Synopsis: Many patients with diabetes are under sub-optimal glycemic control. Central to the clinicianÂ’s task in improving glycemic control is the management of hypoglycemic medication therapy, including the use of drugs such as insulin and sulfonylureas. Clinical trials have demonstrated that more intensive hypoglycemic medication therapy results in improved glycemic control. Yet quality measures for this critical process of care have not been developed and we know little about how physicians actually manage hypoglycemic medications. We propose to develop a quality measure that describes the intensity of physiciansÂ’ hypoglycemic medication therapy. We will then provide feedback to VA physicians regarding their practices and access to experts in diabetes care to determine whether this intervention leads to improvements in glycemic control. The study is divided into two phases. During the first phase we will use existing data to model the decision to increase hypoglycemic medications. At each medical visit, we will determine whether an increase in medication therapy occurred. We will use recursive partitioning to develop a model that identifies patient characteristics at the visit, such as recent laboratory results and diagnoses, associated with the decision to increase therapy. This model assigns a predicted probability of an increase in therapy to each visit. We then use these predictions to define an intensity of hypoglycemic medication therapy for each pysician that compares the actual to predicted number of increases over all patient-visits. The second phase will be a randomized trial in which clinicians at experimental sites receive feedback on performance and access to expert opinion while usual care is provided at control sites. Feedback on performance will be provided twice over six months. The change in intensity of treatment scores and glycosylated hemoglobin levels pre- and post-intervention at these sites will be compared to performance of primary care physicians at eight control sites not receiving the intervention.
Details:
Eligibility:
Study Type:  Observational, Natural History, Cross-Sectional, Defined Population, Retrospective Study
Minimum Age/Maximum Age: 18 Years/
Genders: Both
Protocol Entry Criteria: 
Total Enrollment: 0

Location and Contact Information:

VA New England Health Care System
Bedford,  Massachusetts,  01730
United States
 


Additional Information:
Study ID Numbers:  DII 99-205; 
Study Start Date: July 1999
Record last reviewed: October 2001
Additional information available at: clinicaltrials.gov
Clinicaltrials.gov Reference link: NCT00012675

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