National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Blood Pressure (3)
- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- Chronic Conditions (6)
- Clinician-Patient Communication (1)
- Community-Based Practice (1)
- Comparative Effectiveness (2)
- Critical Care (1)
- Decision Making (1)
- (-) Diabetes (28)
- Diagnostic Safety and Quality (2)
- Disparities (3)
- Education: Patient and Caregiver (1)
- Elderly (1)
- Electronic Health Records (EHRs) (5)
- Eye Disease and Health (1)
- Healthcare Costs (1)
- Health Information Technology (HIT) (8)
- Health Promotion (1)
- Heart Disease and Health (2)
- Hospitalization (1)
- Lifestyle Changes (2)
- Maternal Care (1)
- Medicare (1)
- Medication (6)
- Mortality (1)
- Obesity (1)
- Obesity: Weight Management (1)
- Outcomes (3)
- Patient-Centered Healthcare (2)
- Patient Adherence/Compliance (2)
- Patient Experience (1)
- Patient Self-Management (6)
- Practice Patterns (1)
- Pregnancy (1)
- Prevention (2)
- Primary Care (1)
- Provider: Health Personnel (1)
- Quality Improvement (2)
- Quality Indicators (QIs) (1)
- Quality Measures (3)
- Quality of Care (2)
- Quality of Life (2)
- Racial and Ethnic Minorities (4)
- Risk (1)
- Screening (1)
- Sex Factors (1)
- Social Determinants of Health (1)
- Teams (2)
- Telehealth (2)
- Transitions of Care (1)
- Treatments (1)
- Women (1)
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
1 to 25 of 28 Research Studies DisplayedVan der Wees PJ, Friedberg MW, Guzman EA
Comparing the implementation of team approaches for improving diabetes care in community health centers.
The researchers sought to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. They found that CHW and MA responsibilities converged over time to focus on health coaching of diabetic patients, with the MA health coaches experiencing difficulty in allocating dedicated time due to other responsibilities. Time constraints also limited the personal introduction of patients to health coaches by clinicians. Participants highlighted the importance of a supportive team climate and proactive leadership as important enablers for MAs and CHWs to implement their health coaching responsibilities. This study suggests that a flexible approach to implementing health coaching is more important than fidelity to rigid models that do not allow for variable allocation of responsibilities across team members.
AHRQ-funded; HS020120.
Citation: Van der Wees PJ, Friedberg MW, Guzman EA .
Comparing the implementation of team approaches for improving diabetes care in community health centers.
BMC Health Serv Res 2014 Dec 3;14:608. doi: 10.1186/s12913-014-0608-z.
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Keywords: Community-Based Practice, Diabetes, Patient-Centered Healthcare, Quality Improvement, Teams
Prentice JC, Conlin PR, Gellad WF
Capitalizing on prescribing pattern variation to compare medications for type 2 diabetes.
This study used observational quasi-experimental methods using instrumental variables (IVs) to compare the effect of two hypoglycemic medications, sulfonylureas (SUs) and thiazolidinediones (TZDs), on long-term outcomes. It found that individuals who used an SU as a second-line agent experienced significantly more adverse long-term health outcomes than did individuals who started on a TZD.
AHRQ-funded; HS019708.
Citation: Prentice JC, Conlin PR, Gellad WF .
Capitalizing on prescribing pattern variation to compare medications for type 2 diabetes.
Value Health 2014 Dec;17(8):854-62. doi: 10.1016/j.jval.2014.08.2674..
Keywords: Diabetes, Medication, Outcomes, Comparative Effectiveness
Sentell TL, Juarez DT, Ahn HJ
Disparities in diabetes-related preventable hospitalizations among working-age Native Hawaiians and Asians in Hawai'i.
Elderly (65+) Native Hawaiian, Filipino, and Japanese men and Filipino women have a higher risk of diabetes-related potentially preventable hospitalizations than whites. The authors sought to determine if similar disparities are seen among the non-elderly (< 65). They found that preventable hospitalizations rates were significantly higher for Native Hawaiians males compared to whites, but significantly lower for Chinese men and women, Japanese men and women, and Filipino men and women. Rates for Native Hawaiian females did not differ significantly from Whites. Disparities in diabetes-related preventable hospitalizations were seen for working-age (18-64) Native Hawaiian men even when their higher population-level diabetes prevalence was considered.
AHRQ-funded; HS019990.
Citation: Sentell TL, Juarez DT, Ahn HJ .
Disparities in diabetes-related preventable hospitalizations among working-age Native Hawaiians and Asians in Hawai'i.
Hawaii J Med Public Health 2014 Dec;73(12 Suppl 3):8-13.
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Keywords: Diabetes, Disparities, Hospitalization, Quality Indicators (QIs), Racial and Ethnic Minorities
Schmittdiel J, Raebel M, Dyer W
Medicare Star excludes diabetes patients with poor CVD risk factor control.
This study is designed to improve understanding of novel CMS quality measures (adherence to antihypertensives, antihyperlipidemics, and oral antihyperglycemics) by assessing the proportion of Medicare patients with diabetes who are excluded from the Medicare Star medication adherence metrics due to early nonadherence and insulin use. Medicare’s STAR measures are used to evaluate the performance of Medicare Advantage plans.
AHRQ-funded; HS019859
Citation: Schmittdiel J, Raebel M, Dyer W .
Medicare Star excludes diabetes patients with poor CVD risk factor control.
Am J Manag Care. 2014 Dec; 20(12):e573-81..
Keywords: Medicare, Diabetes, Quality Measures, Patient Adherence/Compliance
Heisler M, Choi H, Palmisano G
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
This study compared outcomes between community health worker (CHW) use of a tailored, interactive, Web-based, tablet computer-delivered tool specifically developed for the study and use of printed educational materials. In a population of low-income Latino and African American adults with diabetes and relatively low levels of formal education, participants in both CHW-led interventions reported mostly similar improvements in outcomes over 3 months.
AHRQ-funded; HS019256
Citation: Heisler M, Choi H, Palmisano G .
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
Ann Intern Med. 2014 Nov 18;161(10 Suppl):S13-22. doi: 10.7326/m13-3012..
Keywords: Health Information Technology (HIT), Diabetes, Decision Making, Outcomes, Social Determinants of Health
Nundy S, Mishra A, Hogan P
How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study.
The purpose of this study was to investigate the behavioral effects of a theory-driven, mobile phone–based intervention that combines automated text messaging and remote nursing, using an automated, interactive text messaging system. It found that the intervention was associated with improvements in 5 of 6 domains of self-care (medication taking, glucose monitoring, foot care, exercise, and healthy eating).
AHRQ-funded; HS015054.
Citation: Nundy S, Mishra A, Hogan P .
How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study.
Diabetes Educ 2014 Nov-Dec;40(6):806-19. doi: 10.1177/0145721714551992..
Keywords: Diabetes, Health Information Technology (HIT), Patient Self-Management, Telehealth
Mitchell SE, Mako M, Sadikova E
The comparative experiences of women in control: diabetes self-management education in a virtual world.
The investigators characterized participants' experiences of a diabetes self-management (DSM) education program delivered via a virtual world (VW) versus a face-to-face (F2F) format. They found that VW and F2F groups both reported mastery of DSM knowledge, attitudes, and skills, and there were no differences in peer-derived social support between groups. The technological aspects of VW participation afforded VW participants a unique sense of personal agency and diabetes self-efficacy not reported by F2F participants. They concluded that DSM education in a VW is feasible and educational outcomes are similar to a F2F classroom experience.
AHRQ-funded; HS019771.
Citation: Mitchell SE, Mako M, Sadikova E .
The comparative experiences of women in control: diabetes self-management education in a virtual world.
J Diabetes Sci Technol 2014 Nov;8(6):1185-92. doi: 10.1177/1932296814549829.
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Keywords: Education: Patient and Caregiver, Diabetes, Health Promotion, Patient Self-Management
Chen R, Cheadle A, Johnson D
US trends in receipt of appropriate diabetes clinical and self-care from 2001 to 2010 and racial/ethnic disparities in care.
The purpose of this study was to examine trends in the receipt of 8 recommended diabetes clinical and self-care indicators from 2001 to 2010 and assess racial/ethnic disparities in care. There were significant increases from 2001 to 2010 in A1C tests, annual foot exams, flu shots, diabetes self-management education and self management of blood glucose but declines in eye and self feet exams.
AHRQ-funded; HS013853.
Citation: Chen R, Cheadle A, Johnson D .
US trends in receipt of appropriate diabetes clinical and self-care from 2001 to 2010 and racial/ethnic disparities in care.
Diabetes Educ 2014 Nov-Dec;40(6):756-66. doi: 10.1177/0145721714546721..
Keywords: Diabetes, Patient Self-Management, Disparities, Racial and Ethnic Minorities, Racial and Ethnic Minorities
Voils CI, Sleath B, Maciejewski ML
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
The researchers sought to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply. They found that, with patients from a Veterans Affairs (VA) Medical Center, multiple prescribers arose through referrals and patients actively seeking non-VA prescribers to maximize timeliness and access to medications, to provide access to medications not on the VA formulary, and to minimize out-of-pocket costs.
AHRQ-funded; HS019445.
Citation: Voils CI, Sleath B, Maciejewski ML .
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
BMC Health Serv Res 2014 Oct 25;14:490. doi: 10.1186/s12913-014-0490-8.
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Keywords: Chronic Conditions, Medication, Diabetes, Blood Pressure, Heart Disease and Health
Chung S, Azar KM, Baek M
Reconsidering the age thresholds for type II diabetes screening in the U.S.
In order to examine the optimal age cut-point for opportunistic universal screening (as opposed to targeted screening), the researchers used a nationally representative sample from the National Health and Nutrition Examination Survey (2007-2010) and other resources. They found that opportunistic screening among individuals 35 years of age and older could greatly reduce the prevalence of undiagnosed diabetes or pre-diabetes.
AHRQ-funded; HS019815; HS019815.
Citation: Chung S, Azar KM, Baek M .
Reconsidering the age thresholds for type II diabetes screening in the U.S.
Am J Prev Med. 2014 Oct;47(4):375-81. doi: 10.1016/j.amepre.2014.05.012..
Keywords: Diabetes, Screening, Prevention, Chronic Conditions
Benkert R, Dennehy P, White J
Diabetes and hypertension quality measurement in four safety-net sites: lessons learned after implementation of the same commercial electronic health record.
The authors described what implementation of a commercially available EHR with built-in quality query algorithms showed us about our care for diabetes and hypertension populations in four safety net clinics. They found that utilizing a shared EHR, a Regional Extension Center-like partnership model, and similar quality query algorithms allowed safety-net clinics to benchmark and improve the quality of care across differing patient populations and health care delivery models.
AHRQ-funded; HS017191.
Citation: Benkert R, Dennehy P, White J .
Diabetes and hypertension quality measurement in four safety-net sites: lessons learned after implementation of the same commercial electronic health record.
Appl Clin Inform 2014 Aug 20;5(3):757-72. doi: 10.4338/aci-2014-03-ra-0019.
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Keywords: Diabetes, Blood Pressure, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care, Chronic Conditions
Leung LA, Swaminathan S, Trivedi AN
Diabetes diagnosis and exercise initiation among older Americans.
The investigators sought to determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. They found that over 35% of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis.
AHRQ-funded; HS000011.
Citation: Leung LA, Swaminathan S, Trivedi AN .
Diabetes diagnosis and exercise initiation among older Americans.
Prev Med 2014 Aug;65:128-32. doi: 10.1016/j.ypmed.2014.05.001.
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Keywords: Diabetes, Diagnostic Safety and Quality, Elderly, Lifestyle Changes, Patient Self-Management
Zhang R, Lee JY, Jean-Jacques M
Factors influencing the increasing disparity in LDL cholesterol control between white and black patients with diabetes in a context of active quality improvement.
The authors conducted a retrospective analysis of black and white patients treated continuously between 2008 and 2010 in order to examine possible causes of an increased disparity in low-density lipoprotein (LDL) cholesterol control following a multifaceted physician-directed quality improvement (QI) initiative. They found that physician-facing, general QI interventions may be insufficient to produce equity in LDL cholesterol control, and that helping patients maintain prior success controlling cholesterol appears as important in addressing this disparity as is helping uncontrolled patients achieve control.
AHRQ-funded; HS021141.
Citation: Zhang R, Lee JY, Jean-Jacques M .
Factors influencing the increasing disparity in LDL cholesterol control between white and black patients with diabetes in a context of active quality improvement.
Am J Med Qual 2014 Jul-Aug;29(4):308-14. doi: 10.1177/1062860613498112.
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Keywords: Heart Disease and Health, Diabetes, Disparities, Quality Improvement, Racial and Ethnic Minorities
Strom Williams JL, Lynch CP, Winchester R
Gender differences in composite control of cardiovascular risk factors among patients with type 2 diabetes.
This study examined the gender differences in multiple cardiovascular disease (CVD) risk factor control in adults with type 2 diabetes seen in diverse clinical settings. It found that women had significantly poorer composite control of CVD risk outcomes compared with men, adjusting for relevant confounding factors. In unadjusted analyses, women had higher mean systolic blood pressure and LDL cholesterol levels compared with men.
AHRQ-funded; HS011418.
Citation: Strom Williams JL, Lynch CP, Winchester R .
Gender differences in composite control of cardiovascular risk factors among patients with type 2 diabetes.
Diabetes Technol Ther 2014 Jul;16(7):421-7. doi: 10.1089/dia.2013.0329..
Keywords: Cardiovascular Conditions, Risk, Diabetes, Outcomes, Sex Factors
Raebel MA, Ellis JL, Schroeder EB
Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study.
The aim of this study was to characterize antihyperglycemic intensification during the first year after initiating oral antihyperglycemic therapy among adult patients with incident diabetes. The researchers found that 43.5 percent of patients with diabetes had treatment intensified within 1 year of starting antihyperglycemic medication. HbA1c of less than 7 percent was achieved in a very high proportion of patients (65.1 percent).
AHRQ-funded; HS019859
Citation: Raebel MA, Ellis JL, Schroeder EB .
Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study.
Pharmacoepidemiol Drug Saf, 2014 Jul;23(7):699-710. doi: 10.1002/pds.3610..
Keywords: Diabetes, Prevention, Medication
Hirsch AG, Scheck McAlearney A
Measuring diabetes care performance using electronic health record data: the impact of diabetes definitions on performance measure outcomes.
The authors examined the use of electronic health record (EHR) data for diabetes performance measurement. They found that diabetes performance measures are influenced by the data elements used to identify patients. They recommended that as EHR data are used increasingly to measure performance, continuing to improve our understanding of how EHR data are collected and used will be critical.
AHRQ-funded; HS020165.
Citation: Hirsch AG, Scheck McAlearney A .
Measuring diabetes care performance using electronic health record data: the impact of diabetes definitions on performance measure outcomes.
Am J Med Qual 2014 Jul-Aug;29(4):292-9. doi: 10.1177/1062860613500808.
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Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Measures
Schmittdiel JA, Raebel MA, Dyer W
Prescription medication burden in patients with newly diagnosed diabetes: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) study.
The purpose of this study is to use electronic health records to examine how many classes of drugs are used by newly diagnosed patients with diabetes immediately before and after the diagnosis of diabetes. Before diagnosis, these patients are using an average of 5 drug classes, and afterwards, use rises to an average of 6.6. Between 2005 and 2009, the average number of drug classes used after diagnosis decreased slightly.
AHRQ-funded; HS01985
Citation: Schmittdiel JA, Raebel MA, Dyer W .
Prescription medication burden in patients with newly diagnosed diabetes: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) study.
J Am Pharm Assoc 2014 Jul-Aug;54(4):374-82. doi: 10.1331/JAPhA.2014.13195..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Medication
Sorkin DH, Mavandadi S, Rook KS
AHRQ Author: Ngo-Metzger Q
Dyadic collaboration in shared health behavior change: the effects of a randomized trial to test a lifestyle intervention for high-risk Latinas.
The authors sought to evaluate the feasibility of a pilot, dyad-based lifestyle intervention, the Unidas por la Vida program, for improving weight loss and dietary intake among high-risk Mexican American mothers with Type 2 diabetes and their overweight/obese adult daughters. They found that, at 16 weeks, Unidas participants lost significantly more weight compared with the control participants, and intervention participants also were more likely to be eating foods with lower glycemic load and less saturated fat. They concluded that interventions that draw upon multiple people who share a health-risk have the potential to foster significant changes in lifestyle behaviors and in social network members' health-related involvement.
AHRQ-authored.
Citation: Sorkin DH, Mavandadi S, Rook KS .
Dyadic collaboration in shared health behavior change: the effects of a randomized trial to test a lifestyle intervention for high-risk Latinas.
Health Psychol 2014 Jun;33(6):566-75. doi: 10.1037/hea0000063.
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Keywords: Diabetes, Lifestyle Changes, Obesity, Racial and Ethnic Minorities, Obesity: Weight Management
Camelo Castillo W, Boggess K, Stürmer T
Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000-2011.
The researchers sought to characterize pharmacologic treatment of women with gestational diabetes (GDM) by describing trends in the use of glyburide compared with insulin over the past decade (2000-2011) and identifying predictors of initial choice of pharmacotherapy. They found that glyburide has replaced insulin as the more common pharmacotherapy for GDM among those privately insured.
AHRQ-funded; HS017950
Citation: Camelo Castillo W, Boggess K, Stürmer T .
Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000-2011.
Obstet Gynecol. 2014 Jun;123(6):1177-84. doi: 10.1097/AOG.0000000000000285..
Keywords: Diabetes, Maternal Care, Medication, Practice Patterns, Pregnancy, Women
Lanspa MJ, Dickerson J, Morris AH
Coefficient of glucose variation is independently associated with mortality in critically ill patients receiving intravenous insulin.
The researchers studied the association between coefficient of variation of glucose and mortality and also whether the association between glycemic variability and mortality was independent of hypoglycemia and other patient attributes. They found that blood glucose coefficient of variation was associated with 30-day mortality both in diabetic as well as in non-diabetic patients. The association was independent of hypoglycemia, blood glucose target, age, disease severity, and comorbidities.
AHRQ-funded; HS006594.
Citation: Lanspa MJ, Dickerson J, Morris AH .
Coefficient of glucose variation is independently associated with mortality in critically ill patients receiving intravenous insulin.
Crit Care 2014 Apr 30;18(2):R86. doi: 10.1186/cc13851..
Keywords: Critical Care, Mortality, Diabetes
Navar-Boggan AM, Fanaroff A, Swaminathan A
The impact of a measurement and feedback intervention on blood pressure control in ambulatory cardiology practice.
This study evaluated the impact of a targeted provider feedback intervention on rates of blood pressure control. Providers received quarterly provider-specific reports over a period of one year for a group of 300 patients treated in outpatient cardiology clinic practices. These reports as a stand-alone intervention did not affect overall BP control rates in cardiology clinics.
AHRQ-funded; HS021092
Citation: Navar-Boggan AM, Fanaroff A, Swaminathan A .
The impact of a measurement and feedback intervention on blood pressure control in ambulatory cardiology practice.
Am Heart J. 2014 Apr;167(4):466-71. doi: 10.1016/j.ahj.2013.12.015..
Keywords: Blood Pressure, Ambulatory Care and Surgery, Diabetes, Chronic Conditions, Quality Measures, Quality of Care
Everett CM, Thorpe CT, Palta M
The roles of primary care PAs and NPs caring for older adults with diabetes.
The investigators proposed a multidimensional characterization of PA and NP roles on panels of primary care patients with diabetes. They found that PAs and NPs in primary care perform a variety of roles and frequently perform multiple roles within a clinic.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett CM, Thorpe CT, Palta M .
The roles of primary care PAs and NPs caring for older adults with diabetes.
Jaapa 2014 Apr;27(4):45-9. doi: 10.1097/01.jaa.0000444736.16669.76.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams
Nundy S, Dick JJ, Chou CH
Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants.
Mobile phones are a promising tool to use in engaging patients in behavior change and facilitating self-care between visits. The researchers examined the impact of a six-month mobile health (mHealth) demonstration project among adults with diabetes. In addition to pre-post improvements in glycemic control and patients’ satisfaction with overall care, they observed a net cost savings of 8.8 percent.
AHRQ-funded; HS000084.
Citation: Nundy S, Dick JJ, Chou CH .
Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants.
Health Aff 2014 Feb;33(2):265-72. doi: 10.1377/hlthaff.2013.0589..
Keywords: Diabetes, Health Information Technology (HIT), Patient Adherence/Compliance, Patient Self-Management, Telehealth
Pershing S, Enns EA, Matesic B
Cost-effectiveness of treatment of diabetic macular edema.
The researchers sought to determine the cost-effectiveness of different treatments of diabetic macular edema (DME). They found that vascular endothelial growth factor (VEGF) inhibitors with or without laser treatment provide important health benefits with favorable cost-effectiveness, costing less per QALY gained than many accepted therapies.
AHRQ-funded; HS000028.
Citation: Pershing S, Enns EA, Matesic B .
Cost-effectiveness of treatment of diabetic macular edema.
Ann Intern Med 2014 Jan 7;160(1):18-29. doi: 10.7326/m13-0768..
Keywords: Diabetes, Eye Disease and Health, Healthcare Costs, Quality of Life, Treatments
Ritholz MD, Wolpert H, Beste M
Patient-provider relationships across the transition from pediatric to adult diabetes care: a qualitative study.
The purpose of this study was to explore perceptions that emerging adults with type 1 diabetes (T1D) have of their patient-provider relationships across the transition from pediatric to adult care. Several themes emerged from the analysis including the importance of improving provider approaches to transition. Patients recommended that pediatric providers actively promote emerging adults’ autonomy while maintaining parental support.
AHRQ-funded; HS000063.
Citation: Ritholz MD, Wolpert H, Beste M .
Patient-provider relationships across the transition from pediatric to adult diabetes care: a qualitative study.
Diabetes Educ 2014 Jan-Feb;40(1):40-7. doi: 10.1177/0145721713513177..
Keywords: Chronic Conditions, Diabetes, Patient Experience, Clinician-Patient Communication, Transitions of Care