Rationale, design, and implementation of a cluster randomized trial using certified diabetes educators to intensify treatment for glycemia, blood pressure and lipid control: REMEDIES 4D.

Background: Evidence supports that adequate treatment of hyperglycemia, hypercholesterolemia, and hypertension can reduce morbidity and mortality in people with diabetes, however achieving treatment goals remains elusive. The majority of diabetes care occurs in the primary care setting; however there are often missed opportunities for timely intervention during office visits. This paper describes a systematic redesign of current diabetes treatment in primary care by implementing evidence-based protocols.

Using the American Association of Diabetes Educators Outcomes System to identify patient behavior change goals and diabetes educator responses.

Purpose: The purpose of this article is to ascertain patients' self-identified and mutually identified or agreed on (working with diabetes educators) behavior change goals and examine the diabetes educators' response to these goals during the provision of diabetes self-management education.

Methods: The American Association of Diabetes Educators Outcome System was integrated into Web-based, touch-screen, and telephonic systems within 8 sites within the Pittsburgh Regional Initiative for Diabetes Education network. Data from patients and their diabetes educators were obtained from the Diabetes Self-management Assessment Report Tool (D-SMART) and Diabetes Educator Tool (D-ET).

Translating the chronic care model into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention.

Objective: To determine whether using the chronic care model (CCM) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes.

Research Design And Methods: This multilevel, cluster-design, randomized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community. Eleven primary care practices, along with their patients, were randomized to three groups: CCM intervention (n = 30 patients), provider education only (PROV group) (n = 38), and usual care (UC group) (n = 51).

Deploying the chronic care model to implement and sustain diabetes self-management training programs.

Purpose: The purpose of this project was to evaluate the utility of using the 6 elements of the chronic care model (CCM; health system, community, decision support, self-management support, clinical information systems, and delivery system design) to implement and financially sustain an effective diabetes self-management training (DSMT) program.

Methods: The University of Pittsburgh Medical Center (UPMC) uses all elements of the CCM. Partnerships were formed between UPMC and western Pennsylvanian community hospitals and practices; the American Diabetes Association DSMT recognition program provided decision support.