A Study of the Effect of a Chronic Disease Management System on Diabetes Care Within Multidisciplinary Primary Care Practices in Ontario
The purpose of this study is to evaluate the impact of using a web-based (P-PROMPT) chronic disease management system (CDMS) by primary care practitioners and their team members and on their care for patients with diabetes. The system will help to ensure that all patients have up-to-date laboratory monitoring and visits as recommended by the Canadian Diabetes Association Guidelines. The hypothesis is that the use of a CDMS in Ontario primary care practices, as a part of the routine clinical management of diabetes patients, can improve monitoring frequency of A1C, blood pressure (BP) and cholesterol levels. The results of this study will serve as a benchmark for the utilization of chronic disease management software tools in primary care diabetes management for patients in Ontario, establishing and providing evidence to inform decision-makers. If the results are favorable towards CDMS interventions for the management of diabetes, potential expansion and availability of these types of programs may be possible for other chronic diseases.
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Challenging the Ontario Diabetes Care Quality Gap: Evaluation and Long-Term Cost-Utility Analysis of Using a Chronic Disease Management System (CDMS) in Primary Health Care Practices in Ontario (ODIAC-CDMS): A Prospective, Observational, Comparative Study of the Effect of a CDMS on Diabetes Care Within Multidisciplinary Primary Care Practices in Ontario.|
- Change in monitoring frequency [ Time Frame: 1 year ] [ Designated as safety issue: No ]Change in proportion of patients, with up-to-date monitoring of A1C (6 months), blood pressure (annually) and cholesterol (6 months) in practices using a CDMS for 1 year
|Study Start Date:||June 2009|
|Study Completion Date:||March 2012|
|Primary Completion Date:||October 2011 (Final data collection date for primary outcome measure)|
Practice Guidelines recommend that patients with chronic diseases should be monitored with specified clinical measurements each with regular repeats at different specified time intervals or on specified conditions. It is virtually impossible for health care providers to adhere consistently to guidelines and to do so sustainability as well as equitably for "most if not all" of their patients with diabetes. Ontario Health Technology Advisory Committee (OHTAC) has requested the following study. Aggregate monthly primary care practice level data will form the basis of the analysis. Primary care practitioners in Ontario will be enrolled. Differences in 1-year outcome measures within will be performed. Baseline, 2 month, 6 month and 12 month site team member surveys will be completed. Using patient level data from each site, a cost-utility analysis will be conducted. Six aspects related to the use of the CDMS will be examined.
- Change in proportion of the patients in whom monitoring frequency is up to date for A1C, blood pressure and cholesterol.
- Change in proportion of patients who are well controlled with A1C < 0.07, blood pressure < 130/80 and LDL-cholesterol < 2.0.
- Change from baseline across sites in the percentage of patients with an up-to-date foot exam, retinopathy screening, use of angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) and documentation of self-management goals.
- Site questionnaires.
- Changes in physician MOHLTC diabetes incentive billings.
- Long-term cost-utility of the use of the CDMS.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00914706
|Brockville Family Health Team|
|Brockcillw, Ontario, Canada, K6C 0A5|
|Delhi Family Health Team|
|Delhi, Ontario, Canada, N4B 2L8|
|Summerville Family Health Team|
|Etobicoke, Ontario, Canada, M9C 5N2|
|Harrow Health Centre|
|Harrow, Ontario, Canada, N0R 1G0|
|Leamington and Area Family Health Team|
|Lemington, Ontario, Canada, N8H 1N9|
|Sherbourne Family Health Team|
|Toronto, Ontario, Canada, M5A 2S5|
|Principal Investigator:||Ron Goeree||St. Joseph's Healthcare Hamilton/McMaster University|