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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 226 Research Studies DisplayedHung A, Mullins CD, Slejko JF
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
This study projected cost savings to the TRICARE program from changes to the antidiabetic formulary and utilization management (UM) policies. Budgetary impacts for 3 years as projected using a Microsoft Excel spreadsheet. This model projected a savings of up to $43 million in the third year from revisions to the payer’s formulary.
AHRQ-funded; HS024857.
Citation: Hung A, Mullins CD, Slejko JF .
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
J Manag Care Spec Pharm 2019 Mar;25(3):342-49. doi: 10.18553/jmcp.2019.25.3.342..
Keywords: Care Management, Elderly, Healthcare Costs, Medication, Policy
Bell KM, Onyeukwu C, McClincy MP
Verification of a portable motion tracking system for remote management of physical rehabilitation of the knee.
The authors of this paper developed a remote rehabilitation management system combining two wireless inertial measurement units (IMUs) with an interactive mobile application and a web-based clinician portal (interACTION). The aim of their study was to verify the accuracy of the IMU-based knee angle measurement system during three common physical therapy exercises, quantify the effect of visual feedback on exercise performance, and understand the qualitative experience of the user interface through survey data.
AHRQ-funded; HS022989.
Citation: Bell KM, Onyeukwu C, McClincy MP .
Verification of a portable motion tracking system for remote management of physical rehabilitation of the knee.
Sensors 2019 Feb 28;19(5). doi: 10.3390/s19051021..
Keywords: Care Management, Health Information Technology (HIT), Orthopedics, Rehabilitation, Telehealth
Parthipan A, Banerjee I, Humphreys K
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
Researchers employed a machine-learning approach to identify patients who were prescribed a combination of selective serotonin reuptake inhibitors (SSRIs) and prodrug opioids in order to examine the effect of this combination on postoperative pain control. They identified patients who received surgery over a 9-year period by using EHR data from an academic medical center, then developed and validated natural language processing (NLP) algorithms to extract depression-related information from both structured and unstructured data elements. The machine-learning algorithm accurately predicted the increase or decrease of the discharge, 3-week, and 8-week follow-up pain scores when compared to the pre-operative pain score; pre-operative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. The researchers conclude that their study results provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. They suggest that prescribers might choose direct acting opioids such as oxycodone or morphine for depressed patients on SSRIs instead of prodrug opioids.
AHRQ-funded; HS024096.
Citation: Parthipan A, Banerjee I, Humphreys K .
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
PLoS One 2019 Feb 6;14(2):e0210575. doi: 10.1371/journal.pone.0210575..
Keywords: Care Management, Depression, Medication, Opioids, Pain, Surgery
Chan CW, Green LV, Lekwijit S
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
In this study, the authors focused on estimating costs and benefits in a complex healthcare setting where the major differentiation among server types is the intensity of the service provided. They used data from ten hospitals and found that a step-down unit may be a cost-effective way to treat patients when used for those who are post-intensive care unit. However, they also found that the impact of step-down-unit care is more nuanced for patients admitted from the emergency department and may result in increased mortality risk and hospital length of stay for patients who should be treated in the intensive care unit. The authors recommended more study in this area.
AHRQ-funded; HS018480.
Citation: Chan CW, Green LV, Lekwijit S .
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
Management Science 2019 Feb;65(2):751-75. doi: 10.1287/mnsc.2017.2974..
Keywords: Care Management, Healthcare Costs, Healthcare Delivery, Hospitals, Inpatient Care
Phillippi JC, Holley SL, Thompson JL
A planning checklist for interprofessional consultations for women in midwifery care.
This article describes a planning checklist tool designed by using feedback from women, nurses, midwives, and physicians, to improve communication within one health system and to develop a community-engaged approach for the care of women who began care with midwives but developed risks for poor perinatal outcomes. In feasibility testing, the checklist provided a prompt to generate a comprehensive plan for maternity care and to elucidate the rationale for interventions to women and future health care providers. In post-implementation interviews, women said they were pleased with the information they received, and nurses, midwives, and physicians were positive about improved communication. The article details the creation, implementation, and qualitative evaluation of the planning checklist.
AHRQ-funded; HS024733.
Citation: Phillippi JC, Holley SL, Thompson JL .
A planning checklist for interprofessional consultations for women in midwifery care.
J Midwifery Womens Health 2019 Jan;64(1):98-103. doi: 10.1111/jmwh.12900..
Keywords: Care Coordination, Care Management, Communication, Maternal Care, Pregnancy, Women
Wang D, Ing C, Blinderman CD
Latent class analysis of specialized palliative care needs in adult intensive care units from a single academic medical center.
The purpose of this study was to use latent class analysis to separate ICU patients into different classes of palliative care needs, and to determine if these classes differ in their resource requirements. Using information from ICU patients who received specialized palliative care, researchers extracted reason(s) for consultation from the initial note and entered it into a latent class analysis model to generate mutually exclusive patient classes. Four classes were identified: Pain and Symptom Management, Goals of Care and Advance Directives (GCAD), All Needsand Supportive Care. GCAD patients were least likely to be high utilizers.
AHRQ-funded; HS022941.
Citation: Wang D, Ing C, Blinderman CD .
Latent class analysis of specialized palliative care needs in adult intensive care units from a single academic medical center.
J Pain Symptom Manage 2019 Jan;57(1):73-78. doi: 10.1016/j.jpainsymman.2018.10.270..
Keywords: Care Management, Inpatient Care, Intensive Care Unit (ICU), Palliative Care
Clowse MEB, Eudy AM, Revels J
Provider perceptions on the management of lupus during pregnancy: barriers to improved care.
This paper discusses a focus group that was created of women with lupus who either were pregnant or were planning to get pregnant. Outcomes in women with lupus is bad for more than half of pregnancies for the mother or the fetus. The focus group’s objective was to discuss issues about pregnancy planning and management. Problems include ill-timed pregnancies, and medication non-adherence. Communication gaps between the rheumatologist and the obstetrician/gynecologist can result in confusion for the patient with optimal treatment plans.
AHRQ-funded; HS023443.
Citation: Clowse MEB, Eudy AM, Revels J .
Provider perceptions on the management of lupus during pregnancy: barriers to improved care.
Lupus 2019 Jan;28(1):86-93. doi: 10.1177/0961203318815594..
Keywords: Care Management, Chronic Conditions, Maternal Care, Pregnancy, Provider, Women
Patil SJ, Koopman RJ, Belden J
The role of home BP monitoring: answers to 10 common questions.
This review examines what role home blood-pressure monitoring (HBPM) should take in the management of patients with hypertension. The answers to ten evidence-based questions, with reference to USPSTF recommendations, are used to provide insight. These questions include: Can HPBM be used to confirm a hypertension diagnosis? What are the diagnostic and treatment targets for HBPM? Does HBPM improve control of hypertension? Does HBPM help improve medication adherence? Does HBPM improve BP outcomes?
AHRQ-funded; HS023328.
Citation: Patil SJ, Koopman RJ, Belden J .
The role of home BP monitoring: answers to 10 common questions.
J Fam Pract 2019 Jan/Feb;68(1):29-33..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Home Healthcare, Evidence-Based Practice, Care Management, Guidelines
Lee JH, Nuthall G, Ikeyama T
Tracheal intubation practice and safety across international PICUs: a report from national emergency airway registry for children.
Researchers hypothesized that there would be differences in the process of care and adverse outcomes for tracheal intubation across pediatric ICUs (PICUs) in six different geographical regions: Germany, Japan, Singapore, India, New Zealand, and North America. Adverse tracheal intubation-associated events and desaturation occurrences in PICUS in these regions were evaluated, and the international PICUs compared with those in North America. The proportion of tracheal intubations for endotracheal tube change was greater in international PICUs, and the median age for international tracheal intubations was younger when compared with North America PICUs. Occurrences of adverse tracheal intubation-associated events were slightly lower for international than for North American PICUs, except for Germany and Japan, which were slightly higher.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Lee JH, Nuthall G, Ikeyama T .
Tracheal intubation practice and safety across international PICUs: a report from national emergency airway registry for children.
Pediatr Crit Care Med 2019 Jan;20(1):1-8. doi: 10.1097/pcc.0000000000001782..
Keywords: Adverse Events, Care Management, Children/Adolescents, Intensive Care Unit (ICU), Respiratory Conditions, Outcomes, Patient Safety
Wahl TS, Goss LE, Morris MS
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
The purpose of this study was to investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery. The authors hypothesized that ERAS would reduce disparities in pLOS between black and white patients. They concluded that ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications.
AHRQ-funded; HS013852.
Citation: Wahl TS, Goss LE, Morris MS .
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
Ann Surg 2018 Dec;268(6):1026-35. doi: 10.1097/sla.0000000000002307..
Keywords: Surgery, Racial and Ethnic Minorities, Disparities, Care Management, Healthcare Delivery, Hospitalization, Patient-Centered Outcomes Research, Outcomes
Kranz AM, Dalton S, Damberg C
Using health IT to coordinate care and improve quality in safety-net clinics.
Health centers provide care to vulnerable and high-need populations. Recent investments have promoted use of health information technology (HIT) capabilities for improving care coordination and quality of care in health centers. This study examined factors associated with use of these HIT capabilities and the association between these capabilities and quality of care in a census of health centers in the United States.
AHRQ-funded; HS024067.
Citation: Kranz AM, Dalton S, Damberg C .
Using health IT to coordinate care and improve quality in safety-net clinics.
Jt Comm J Qual Patient Saf 2018 Dec;44(12):731-40. doi: 10.1016/j.jcjq.2018.03.006..
Keywords: Health Information Technology (HIT), Care Coordination, Patient-Centered Healthcare, Quality Improvement, Quality of Care, Vulnerable Populations, Care Management
Shuman CJ, Xie XJ, Herr KA
Sustainability of evidence-based acute pain management practices for hospitalized older adults.
This article reported on the sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation.
AHRQ-funded; HS010482.
Citation: Shuman CJ, Xie XJ, Herr KA .
Sustainability of evidence-based acute pain management practices for hospitalized older adults.
West J Nurs Res 2018 Dec;40(12):1749-64. doi: 10.1177/0193945917738781..
Keywords: Care Management, Elderly, Evidence-Based Practice, Inpatient Care, Pain, Implementation
Wang A, Pollack T, Kadziel LA
Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review.
The goal of this systematic review was to evaluate the impact of practice facilitation on chronic disease outcomes in the primary care setting. Researchers extracted and assessed the quality of the data on chronic disease process and clinical outcome measures from U.S. studies that implemented practice facilitation and reported quantifiable care processes and chronic disease outcomes. The results of this evaluation suggest that practice facilitation may improve chronic disease care measures; practices across all studies were aware of practice facilitation. The authors conclude that the results support the potential expansion of practice facilitation in primary care, but that future work will need to investigate potential opportunities to improve chronic disease outcomes in other health care settings.
AHRQ-funded; HS000084.
Citation: Wang A, Pollack T, Kadziel LA .
Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review.
J Gen Intern Med 2018 Nov;33(11):1968-77. doi: 10.1007/s11606-018-4581-9.
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Keywords: Care Management, Chronic Conditions, Primary Care, Quality of Care, Quality Improvement
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Militello LG, Anders S, Downs SM
Understanding how primary care clinicians make sense of chronic pain.
This research explored how primary care clinicians manage their patients with chronic noncancer pain. They conducted Critical Decision Method interviews with 10 clinicians about 30 individual patients. Findings suggested that clinicians should focus on supporting sensemaking in the content of clinical evidence rather than trying to provide them with rules.
AHRQ-funded; HS023306.
Citation: Militello LG, Anders S, Downs SM .
Understanding how primary care clinicians make sense of chronic pain.
Cogn Technol Work 2018 Nov;20(4):575-84. doi: 10.1007/s10111-018-0491-1..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Shared Decision Making, Primary Care, Care Management
Laughlin-Tommaso SK, Stewart EA
Moving toward individualized medicine for uterine leiomyomas.
In this paper, the authors discuss uterine leiomyomas. They indicate that despite a wide range of symptoms, varying characteristics of the uterus and the leiomyomas themselves, and many alternatives, hysterectomy accounts for almost three fourths of all surgical therapy. They also indicate that there is increasing evidence for a variety of procedural therapies for symptomatic leiomyomas and a new generation of medical therapies under development. They predict the continued evolution of therapy from excisional or interventional therapies to medical therapies and ultimately prediction of at-risk individuals.
AHRQ-funded; HS023418.
Citation: Laughlin-Tommaso SK, Stewart EA .
Moving toward individualized medicine for uterine leiomyomas.
Obstet Gynecol 2018 Oct;132(4):961-71. doi: 10.1097/aog.0000000000002785..
Keywords: Patient-Centered Healthcare, Evidence-Based Practice, Care Management
Hall SF, Wright NC, Wolinsky FD
The prevalence of overtreatment of osteoporosis: results from the PAADRN trial.
There is a robust body of literature addressing undertreatment in osteoporosis, but limited data addressing overtreatment. In this study, the investigators sought to understand overtreatment as this understanding is important to minimizing harm and decrease costs. The investigators found that in their sample of older adults, overuse of osteoporosis pharmacotherapy was only 8.1%. Nevertheless, they concluded, overtreatment exposed patients to possible risk with negligible chance of benefit and should be minimized.
AHRQ-funded; HS023009.
Citation: Hall SF, Wright NC, Wolinsky FD .
The prevalence of overtreatment of osteoporosis: results from the PAADRN trial.
Arch Osteoporos 2018 Sep 28;13(1):103. doi: 10.1007/s11657-018-0517-6..
Keywords: Osteoporosis, Shared Decision Making, Medication, Elderly, Patient-Centered Healthcare, Patient and Family Engagement, Care Management
Symer MM, Yeo HL
Recent advances in the management of anal cancer.
The incidence of anal cancer is gradually increasing. This article discusses the epidemiology and pathogenesis of anal cancer, and the prevention of human papilloma virus (HPV) infection as an important management principle. Screening recommendations from various sources are reviewed, and the authors note that screening for individuals at risk of anal cancer should include anal cytology and anoscopy. Current treatments and special cases are also reviewed; the authors conclude that treatments such biological therapies, therapeutic vaccination, and immunotherapy are likely to improve outcomes in patients with anal cancer.
AHRQ-funded; HS000066.
Citation: Symer MM, Yeo HL .
Recent advances in the management of anal cancer.
F1000Res 2018 Sep 28;7. doi: 10.12688/f1000research.14518.1..
Keywords: Cancer, Care Management, Diagnostic Safety and Quality, Screening
Sterling MR, Silva AF, Robbins L
Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.
This qualitative study examined the role of numeracy (basic number skills) in the management of patients with heart failure (HF). Thirty men and women aged 47-89 years with a history of HF were recruited from an urban academic primary care practice. Participants all had a history of HF within the past year, were seen at the practice within the last year, and had been hospitalized for HF within the last 6 months. They were interviewed about their numeracy to help manage monitoring weight, maintaining a low-salt diet, and monitoring blood pressure. A wide range of knowledge and understanding was found and fear served as a barrier and facilitator to carrying out HF self-care tasks involving numbers. If the patient has a caregiver who also lacks those skills or does not have HF care training, patients may not be managing their HF as well as they should.
AHRQ-funded; HS000066.
Citation: Sterling MR, Silva AF, Robbins L .
Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.
BMJ Open 2018 Sep 19;8(9):e023073. doi: 10.1136/bmjopen-2018-023073..
Keywords: Patient Self-Management, Education: Patient and Caregiver, Care Management, Heart Disease and Health, Nutrition, Lifestyle Changes, Obesity: Weight Management, Obesity, Blood Pressure, Cardiovascular Conditions
Bradley SM, Schweon SJ, Mody L
Identifying safe practices for use of the urinary leg bag drainage system in the postacute and long-term care setting: an integrative review.
In the postacute and long-term care setting, the practice of changing the indwelling urinary catheter large sterile drainage bag to a small-size leg drainage bag is intended to maintain a person's mobility, dignity, and comfort. There is scant evidence that assesses the impact of intermittent use of a leg bag on frequency of urinary tract infection since this breaks the closed urinary drainage system. The investigators identified the existence of low-level evidence that leg bags pose no evident, disproportionate risk of infection compared with maintaining a closed system.
AHRQ-funded; 290201000025I.
Citation: Bradley SM, Schweon SJ, Mody L .
Identifying safe practices for use of the urinary leg bag drainage system in the postacute and long-term care setting: an integrative review.
Am J Infect Control 2018 Sep;46(9):973-79. doi: 10.1016/j.ajic.2018.03.029..
Keywords: Care Management, Evidence-Based Practice, Healthcare-Associated Infections (HAIs), Long-Term Care, Patient Safety, Urinary Tract Infection (UTI)
Ramirez M, Maranon R, Fu J
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
The purpose of this study was to evaluate provider responses to a narrowly targeted Best Practice Advisory (BPA) alert regarding the intensification of blood pressure medications for persons with diabetes before and after implementation of a ‘chart closure’ hard stop. Researchers designed a BPA that sent alerts via an electronic health record system during outpatient encounters when patients with diabetes had elevated blood pressures and were not on angiotensin receptor blocking medications. These alerts were implemented in eight primary care practices within UCLA Health. Data on provider responses to the alerts was compared before and after implementing a ‘chart closure’ hard stop. Providers responded to alerts more often after the ‘chart closure’ hard stop was implemented. The researchers conclude that targeting specific omitted medication classes can produce specific alerts that may reduce alert fatigue, and that using a ‘chart closure’ hard stop may prompt providers to take action without major disruptions to their workflow.
AHRQ-funded; HS000046.
Citation: Ramirez M, Maranon R, Fu J .
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
J Am Med Inform Assoc 2018 Sep;25(9):1167-74. doi: 10.1093/jamia/ocy073..
Keywords: Blood Pressure, Diabetes, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Care Management
Balentine CJ, Leverson G, Vanness DJ
Selecting post-acute care settings after abdominal surgery: are we getting it right?
Using Nationwide Inpatient Sample data, the authors investigated whether variation in post-acute care (PAC) services could be explained by surgeons discharging clinically similar patients to different PAC destinations. They found considerable potential for reducing variation in PAC use and costs by better understanding how surgeons make decisions about PAC placement.
AHRQ-funded; HS023009.
Citation: Balentine CJ, Leverson G, Vanness DJ .
Selecting post-acute care settings after abdominal surgery: are we getting it right?
Am J Surg 2018 Aug;216(2):260-66. doi: 10.1016/j.amjsurg.2017.08.043..
Keywords: Care Management, Shared Decision Making, Healthcare Cost and Utilization Project (HCUP), Surgery, Transitions of Care
Desai K, Carroll I, Asch SM
Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management.
In this study, the investigators sought to assess the association between discharge multimodal analgesia and postoperative pain outcomes in two diverse health care settings. They evaluated patients undergoing four common surgeries associated with high pain in electronic health records from an academic hospital (AH) and Veterans Health Administration (VHA). The investigators found that a majority of surgical patients received a multimodal pain approach at discharge yet many received only opioids. Multimodal regimen at discharge was associated with better follow-up pain and all-cause readmissions compared to the opioid-only regimen.
AHRQ-funded; HS024096.
Citation: Desai K, Carroll I, Asch SM .
Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management.
J Surg Res 2018 Aug;228:160-69. doi: 10.1016/j.jss.2018.03.029..
Keywords: Care Management, Medication, Opioids, Pain, Surgery
Turner TE, Saeed MJ, Novak E
Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality.
Despite the absence of data from randomized clinical trials, professional societies recommend inferior vena cava (IVC) filters for patients with venous thromboembolic disease (VTE) and a contraindication to anticoagulation therapy. Prior observational studies of IVC filters have suggested a mortality benefit associated with IVC filter insertion but have often failed to adjust for immortal time bias. The purpose of this study was to determine the association of IVC filter placement with 30-day mortality after adjustment for immortal time bias.
AHRQ-funded; HS019455.
Citation: Turner TE, Saeed MJ, Novak E .
Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality.
JAMA Netw Open 2018 Jul 6;1(3):e180452. doi: 10.1001/jamanetworkopen.2018.0452.
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Keywords: Blood Thinners, Cardiovascular Conditions, Care Management, Heart Disease and Health, Healthcare Cost and Utilization Project (HCUP), Medication, Outcomes
Pantalone KM, Misra-Hebert AD, Hobbs TM
Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set.
The failure of clinicians to intensify therapy when clinically indicated has been termed “clinical inertia.” This paper discusses clinical inertia in diabetes 2 management.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set.
Diabetes Care 2018 Jul;41(7):e113-e14. doi: 10.2337/dc18-0116..
Keywords: Care Management, Diabetes, Patient-Centered Outcomes Research