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Biomedical subjects

Linda M Siminerio

Publications and source records attributed to Linda M Siminerio.

10 recordsLinked to original sources
PubMed2006

Developing and validating a diabetes database in a large health system.

BACKGROUND: One component of clinical information systems is a registry of patients. Registries allow providers to identify gaps in care at the population level. Registries also allow for rapid cycle continuous quality improvement, targeted practice change and improved outcomes. Most registries are built based on membership with an insurer or other selection criteria. Little, if any data exist on registries representing demographically heterogeneous populations. METHODS: Administrative and clinical data for the period 1/1/2000-12/30/03 were examined. In total, 46,082,941 lab reports, 233,292,544 medical records, and 9,351,415 medical record abstracts, representing approximately 2 million unique patients were searched. The diabetes source population was identified by presence of any one of the following criteria: ICD-9 code 250 (diabetes) for inpatient, emergency room or outpatient visits; any hemoglobin A1c result; blood glucose >200mg/dl; or diabetes medication. A diagnosis of diabetes was verified by trained chart reviewers on a sample of patients. Single indicators and combinations were examined to determine optimal identification of these cases. RESULTS: In two separate validation studies, using two or more indicators or outpatient diagnosis maximized positive predictive value (PPV) (96 and 97%) and sensitivity (99 and 100%) and identified 55,807 individuals. When all patients with a single indicator of outpatient diagnosis (which had the highest single PPV of 94 and 95%) were included together with those having >or=2 indicators, the final sample size was 65,725. CONCLUSION: Two or more indicators or an out-patient-diagnosis identifies a sizeable and unselective diabetes database which can be used to track processes and outcomes.

Databases, Factual↗
PubMed2006

Physician and nurse use of psychosocial strategies in diabetes care: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study.

OBJECTIVE: To determine the use of psychosocial strategies by health care providers in treating patients with diabetes and the factors associated with use of these strategies. RESEARCH DESIGN AND METHODS: Cross-sectional survey of national samples of generalist and diabetes specialist physicians (n = 2,705) and nurses (n = 1,122) from the multinational study of Diabetes Attitudes, Wishes and Needs. Respondents were from 13 countries in Asia, Australia, Europe, and North America. Two psychosocial strategies were examined: provider psychosocial care, which provides psychosocial support by diabetes care providers to their own patients, and psychosocial specialist care, which refers diabetic patients to psychosocial specialists. RESULTS: Compared with physicians, nurses perceived significantly higher prevalence and severity of psychosocial problems and used psychosocial strategies significantly more frequently, even though they rated their own psychosocial skills lower. Among both physicians and nurses, diabetes specialists were significantly more likely than generalists to utilize psychosocial strategies. Physicians and nurses used psychosocial strategies significantly more when they believed that more patients have psychosocial problems and that problems interfere more with diabetes control. Referral to psychosocial specialists was significantly more likely when physicians and nurses perceived that professional psychological resources were more available. There were substantial country differences in all factors studied. Compared with other countries, U.S. providers provided more psychosocial care themselves but were less likely to refer to psychosocial specialists. CONCLUSIONS: Psychosocial strategies are important parts of the diabetes care provider repertoire; understanding their determinants may facilitate efforts to increase their use.

Adult↗
PubMed2006

Health care and patient-reported outcomes: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study.

OBJECTIVE: The purpose of this study was to assess the relationship of patients' self-reported well-being, self-management, and diabetes control with factors related to the patient's health care. RESEARCH DESIGN AND METHODS: This was a cross-sectional survey of national samples of patients with diabetes (n = 5,104) from the multinational study of Diabetes Attitudes, Wishes and Needs (DAWN). Patients from 13 countries in Asia, Australia, Europe, and North America reported their level of well-being, self-management, and diabetes control. Hierarchical multiple regression analysis (blocks are countries, respondent characteristics, and health care features) was used to examine predictors of diabetes-related distress and general well-being, adherence to lifestyle and medical treatment recommendations, and perceived diabetes control and hyperglycemic symptoms. RESULTS: Country, respondent demographic and disease characteristics, and health care features were all associated with patient-reported outcomes. Better patient-provider collaboration was associated with more favorable ratings on all outcomes, and better access to the provider and availability of team care were associated with some positive outcomes. Country differences were only partly accounted for by patient and health care factors. Relationships between health care factors and outcomes varied across countries. CONCLUSIONS: Patients' reports of well-being, self-management, and diabetes control were related to the countries in which they live, their demographic and disease characteristics, and features of their health care. Opportunities to enhance patient-provider collaboration, access to care, and availability of team care should be pursued.

Adult↗
PubMed2006

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). RESULTS: A marked decline in HbA(1c) was observed in the CCM group (-0.6%, P = 0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (P = 0.01). The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group (non-HDL cholesterol: -10.4 mg/dl, P = 0.24; self-monitor blood glucose: +22.2%, P < 0.0001), with statistically significant between-group differences in improvement (non-HDL cholesterol: P = 0.05; self-monitor blood glucose: P = 0.03) after adjustment. The CCM group also showed improvement in HDL cholesterol (+5.5 mg/dl, P = 0.0004), diabetes knowledge test scores (+6.7%, P = 0.07), and empowerment scores (+2, P = 0.02). CONCLUSIONS: These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes.

Aged↗
PubMedDate not supplied

Genetics and type 1 diabetes: online resources for diabetes educators.

PURPOSE: Genetic education Internet sites and peer-reviewed medical literature were reviewed and critiqued to develop tables summarizing online resources for diabetes health professionals. METHODS: Using Internet search engines, each Web site identified for this project met the following criteria: (1) accurate and valid site content based on widely accepted genetic texts, (2) credibility of the organization that maintained the Web site, (3) ease of navigation, and (4) provision of continuing education credits. PubMed was used to find journal articles using similar criteria. RESULTS: There were 33 Web sites on genetic education for diabetes health professionals that met the inclusion criteria. The literature search identified 36 articles regarding the importance of genetic education for nurses and other health professionals, as well as information regarding genetics and diabetes. CONCLUSIONS: Valid and credible information on genetics and type 1 diabetes is available for diabetes health professionals on the Internet and in the medical literature.

Computer-Assisted Instruction↗
PubMedDate not supplied

Genetics and type 1 diabetes: online resources for patients.

PURPOSE: This Web-based review was undertaken to compile online resources for diabetes educators on genetics--specifically, the genetics of type 1 diabetes--and to provide helpful and accurate information for the public. METHODS: Keyword searches were performed to identify Web sites for genetics education for the lay public and for sites specifically geared toward children/young adults. Web sites were critiqued based on credibility (source, currency, relevance/utility), content (accuracy), and design (accessibility, logical organization). Additional keyword searches were conducted to find sites describing the genetics of type 1 diabetes, which were evaluated for content validity. RESULTS: The Web sites selected for general genetics education contain accessible, credible, and accurate information about basic genetics in an easy-to-follow format with both text and visual aides. Although these sites adequately educate the public about genetics, only diabetes-specific Web sites discussed the relationship between genetics and risk for type 1 diabetes associated with high-risk HLA alleles. CONCLUSIONS: In this genomic age, it is important for healthcare professionals to provide genetics information. Educational tools that specifically address the genetics of type 1 diabetes are urgently needed to fill the current information gaps on the Internet.

Computer-Assisted Instruction↗
PubMedDate not supplied

Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice.

PURPOSE: The purpose of this pilot study was to determine the impact of implementing elements of the chronic care model (CCM; decision support, self-management, and delivery system redesign) on providers' diabetes care practices and patient outcomes in a rural practice setting. METHODS: In this pilot study, 104 patients with type 2 diabetes and 6 providers in a rural primary care practice were involved in an intervention that included a certified diabetes educator (CDE) who educated and supported providers on diabetes management and adherence to the American Diabetes Association (ADA) Standards of Care over the year of the project. The CDE also provided diabetes self-management education (DSME) at the office site for 29 of the 104 patients who received their care in the practice. The following variables were evaluated: provider perceived barriers to care and adherence to ADA standards of care and patient A1C, blood pressure, cholesterol, knowledge, and empowerment levels. RESULTS: Provider adherence to ADA Standards of Care increased significantly across all process measures. Patients who received DSME at point of service in the primary care practice setting gained improvements in knowledge, empowerment, A1C, and high-density lipoprotein cholesterol levels. CONCLUSIONS: Implementing systems to support decision support, self-management education, and delivery system redesign has a positive influence on practices and patient outcomes in outlying rural communities.

Aged↗
PubMedDate not supplied

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. A clinical data repository and reorganization of primary care practices aided in supporting DSMT. The following process and patient outcomes were measured: number of recognized programs, reimbursement, patient hemoglobin A1C levels, and the proportion of patients who received DSMT in primary care practices versus hospital-based programs. RESULTS: Using elements of the CCM, the researchers were able to gain administrative support; expand the number of recognized programs from 3 to 21; cover costs through increased reimbursement; reduce hemoglobin A1C levels (P < .0001), and increase the proportion of patients receiving DSMT through delivery in primary care (26.4% suburban; 19.8% urban) versus hospital-based practices (8.3%; P < .0001). CONCLUSIONS: The CCM serves as an effective model for implementing and sustaining DSMT programs.

Chronic Disease↗
PubMedDate not supplied

Implementing diabetes self-management training programs: breaking through the barriers in primary care.

OBJECTIVE: To review issues, examples, and recommendations for the delivery of diabetes self-management training (DSMT) services in the primary care setting. METHODS: Barriers to provision of DSMT at the point of care and strategies to overcome such challenges are discussed. In addition, new avenues to support continuing diabetes education are presented. RESULTS: Diabetes is a complex disease that requires education, monitoring, and medication adjustment to achieve treatment goals. Unfortunately, adequate support is seldom available for the increased time and effort needed for optimal management of diabetes. Health-care delivery systems are designed to provide a response to acute illnesses and are poorly configured to meet the needs of patients with complex chronic illnesses. Although team care and DSMT have proved to be effective, they have infrequently been integrated in primary care offices, where most patients with diabetes receive treatment. It is encouraging that the studies conducted to date have generally found office-based counseling and educational strategies to be effective for the vast majority of patients with diabetes. Community-based programs that extend DSMT have also been successful. CONCLUSION: Diabetes is a chronic disease that requires providers to deliver multifaceted care and patients to be proficient in many self-care skills. Team care and DSMT approaches have been found to yield beneficial results, yet such strategies are seldom used in the primary care office. Thus, models that support the team approach to delivery of diabetes care and self-management education interventions should be explored and encouraged.

Chronic Disease↗