At the time of the study, PPCRN clinics comprised approximately 110 internal medicine and family practice physicians caring for 182 534 patients in 16 clinics. The study was conducted within the Providence Primary Care Research Network (PPCRN) in Oregon within a not-for-profit integrated delivery system. We studied cholesterol management in patients with diabetes mellitus (DM), selected as the target population for the study based on DM's high prevalence, available treatment options, poor disease control, and impact on cardiovascular disease profile. This study evaluates the incremental impact of team-based care in the setting of a fully implemented and adopted electronic medical record (EMR) and disease registry in a community-based primary care setting. How do busy practices best redesign care so that the right work is delegated to the right team member at the right time to provide the most effective outcomes at the lowest cost? 4 There is less specific guidance from these sources or published literature to assist practices in decisions regarding care process redesign following implementation of health information technology (IT). The PCMH framework and financial incentives around meaningful use of electronic health record technology provide clear direction for practices to adopt a certified electronic health record and to have registrylike capabilities. 2 The recently passed healthcare reform bill, the American Recovery and Reinvestment Act of 2009, 3 and specifically Title XIII of the bill offer primary care practices the promise of financial incentives to effectively adopt health information technology and redesign care processes. 1 The PCMH is promoted as a component of the required changes needed to address the health care quality, access, continuity, and cost shortfalls in the United States. Patient-centered medical home (PCMH) is a well-described framework endorsed by the American Academy of Family Physicians and 6 other medical associations. There was no significant difference in patient satisfaction between study arms ( P = .15).Ĭonclusion Remotely located physician-pharmacist team-based care resulted in significantly improved LDL-C levels and goal attainment among patients with DM. Patients in the intervention arm were also 15% more likely to receive a prescription for a lipid-lowering medication ( P = .008). The rate of LDL-C testing was significantly higher in the intervention arm compared with the control arm. The mean LDL-C level was 12 mg/dL lower in the intervention arm compared with the control arm ( P < .001). Patients in the intervention arm were more likely to achieve their target LDL-C levels compared with controls (78% vs 50% P = .003). Results A total of 6963 patients with DM cared for by 68 physicians in 9 clinics were evaluated. Study outcomes included the difference in low-density lipoprotein cholesterol (LDL-C) goal attainment, mean LDL-C, prescribed lipid-lowering therapy, and patient satisfaction between the intervention and control arms. ![]() All clinicians in the study had access to the health information technology tool CareManager, which provided automated DM-related point-of-care prompts, a Web-based registry, and performance feedback with benchmarking. The intervention included remote physician-pharmacist team-based care focused on cholesterol management in DM. Participants at least 18 years of age were identified by a diagnosis of DM. Methods This 2-year prospective, cluster randomized controlled trial was conducted within the Providence Primary Care Research Network in Oregon. This study was designed to evaluate the impact of remote physician-pharmacist team-based care on cholesterol levels in patients with diabetes mellitus (DM).
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