Notes

Outline

The Diabetes Outcomes Study Overview and Update Stephen J. Spann, MD Robert Volk PhD Baylor College of Medicine

Research Team Baylor College of Medicine Stephen J. Spann, MD Robert J. Volk, PhD Valory N. Pavlik, PhD Irene Easling, DrPH AAFP Jim Galliher, PhD John Hickner, MD, MS Herb Young, MD Tom Stewart Center for Research Strategies, University of Colorado Paul Nutting, MD,MSPH University of Minnesota Kevin A. Peterson, MD

Participating Research Networks AAFP National Research Network Minnesota Academy of Family Physicians Research Network (MAFPRN) Texas Academy of Family Physicians Research Network (TAFP R Net) SPUR-Net (Baylor College of Medicine)

Background Diabetes mellitus major cause of mortality and morbidity in the U.S. affects nearly 16 million individuals. cost to society each year of diabetes ~ $100 billion Most of the societal burden of diabetes macrovascular complications microvascular complications

Background Family Practice close scrutiny ability to manage chronic conditions, achieve good outcomes. Current studies do not include the full spectrum of patients subject to selection bias patients c acceptance of diabetes, motivated = > specialist

Diabetes Outcomes Study Objectives to describe the outcomes of type 2 diabetes achieved by primary care physicians and their patients; and to identify the major patient, physician and practice variables that are associated with varying levels of glycemic control and health-related quality of life.

Hierarchical Nature of Research in Primary Care

Domains & Sources of Data for DOS

Methods

Methods Cross-sectional design data provided by physicians and patients. Physicians/patients recruited from AAFP National Research Network Minnesota AFP Research Network SPUR Net TAFP R Net

Methods, cont. Physician Survey completed prior to primary data collection with patients. Physicians identify a Study Coordinator serving as primary liaison with AAFP research office. Study Coordinator packets mailed to sites, with training session conducted by telephone (through AAFP research office).

Methods, cont. AAFP Research Office Activities: Physician recruitment Train Study Coordinators Serve as liaison with sites Track data collection Monitor data completeness Physician/site reimbursement (incentives $$$) Dissemination

Methods, cont. Baylor College of Medicine Activities: Select, pilot and print instruments Sample size estimates and study design Determine study procedures with AAFP office Prepare Study Coordinator Packets IRB (human subjects approvals) Prepare dataset and conduct analyses Dissemination

Study Schema

Study Schema, cont.

Study Schema, cont.

Instruments: Physician Survey Background Information Type of practice (eg, solo) Size of community Payer distribution of patient base Specialty, board certification Years in practice Age, gender

Instruments: Physician Survey Diabetes Management Practice design issues use of other health professionals educational materials on diabetes Electronic medical record diabetes management protocol/flow sheet

Instruments: Physician Survey Perspectives about Diabetes Self-rated success in treating patients with diabetes Acceptable ranges for fasting blood glucose What is the “gold standard” for the diagnosis of DM?

Instruments: Physician Survey Beliefs about Diabetes (5-point Likert Scale adapted from Diabetes Attitude Scale*.) “Tight control is too much work” “It is frustrating to treat patients with diabetes” “I have adequate time and resources to effectively treat my diabetic patients” *Anderson RM, Fitzgerald JT, Funnell MM, Gruppen LD. The third version of the Diabetes Attitude Scale. Diabetes Care 1998; 21(9): 1403-1407.(10)

Instruments: Patient Questionnaire Health-related Quality of Life SF-8TM (Short Form -8) , [newest iteration of the Medical Outcomes study Short Form-36 Health Survey] Audit of Diabetes-Dependent Quality of Life* *Bradley C, Todd C, Gorton E, et al. The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQOL. Quality of Life Research 1999;8:79-91 (2)

Instruments: Patient Questionnaire Beliefs about Diabetes Anderson Diabetes Attitude Scale* Comorbid Health Problems Self-report measure developed by Cass & Volk Barriers to Accessing Care Continuity with Primary Care Physician (PCP) *Anderson RM, Fitzgerald JT, Funnell MM, Gruppen LD. The third version of the Diabetes Attitude Scale. Diabetes Care 1998; 21(9): 1403-1407.(10)

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Results

Recruitment Flow

Physician Characteristics Age: mean = 47 years, range 31-74 Sex: 80.8% male Board certified: 100% Specialty: 95.7% FPs Years in practice: mean = 17 years, range 1 – 45

Type of Practice

Number of Adult Patients with Diabetes Seen in a Typical Month

Percentage of Patients in Managed Care

Use of other health professionals in care of patients with diabetes

Strategies used in caring for patients with diabetes

Strategies used in caring for patients with diabetes Use an electronic medical record: 27.8% Use some kind of diabetes-management protocol/flow-sheet: 72.2%

Acceptable fasting blood glucose range?

Acceptable blood glucose range 2 hours after meals?

“What is the best ‘gold standard’ for diagnosing diabetes?”

Rated Success in Treating Patients with Diabetes

“Tight control is too much work.”

“It is frustrating to treat patients with diabetes.”

“I have adequate time/resources to treat my diabetic patients.”

Results: Physician Surveys

Results: Patient Questionnaires

Summary Comments The Diabetes Outcomes Study examines the outcomes of type 2 diabetes achieved by primary care physicians and their patients. The relationships between major patient, physician, and practice variables with glycemic control and health-related quality of life are being explored. To date, 145 physicians have participated, and 109 (75%) have completed the physician survey.

Summary Comments Physician Survey, preliminary findings: considerable variation in--- # diabetic patients treated in a typical month; the types of other health professionals and practice design factors used in managing patients with diabetes; and physicians’ beliefs and attitudes about the management of diabetes.