Evidence map›Paper›PMID 24445098›Full record

Trial reportAnnals of family medicine

Practice facilitation to improve diabetes care in primary care: a report from the EPIC randomized clinical trial.

W Perry Dickinson, L Miriam Dickinson, Paul A Nutting, Caroline B Emsermann, Brandon Tutt, Benjamin F Crabtree, Lawrence Fisher, Marjie Harbrecht, Allyson Gottsman, David R West

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
52citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

52 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
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  5. Pooled it
  6. Interventions to increase attendance for diabetic retinopathy screening.The Cochrane database of systematic reviews · 2018
    Pooled it
  7. Implementation of Coach McLungsBMC medical informatics and decision making · 2022
    Trial
  8. Trial
  9. Trial
  10. Trial
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  13. Trial
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  17. A Randomized Trial of High-Value Change Using Practice Facilitation.Journal of the American Board of Family Medicine : JABFM
    Trial
  18. Trial
  19. Successful Implementation of Integrated Behavioral Health.Journal of the American Board of Family Medicine : JABFM · 2025
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

W Perry DickinsonDepartment of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado.
L Miriam Dickinson
Paul A Nutting
Caroline B Emsermann
Brandon Tutt
Benjamin F Crabtree
Lawrence Fisher
Marjie Harbrecht
Allyson Gottsman
David R West

Funding

Using Teams for Reflective Adaptation for DiabetesR18DK067083 · NIDDK · UNIVERSITY OF COLORADO DENVER · PI WEST, DAVID R. · 2005 to 2009
$3.1M
Practice Redesign to Improve Depression Care - PRIDE CareR01MH069806 · NIMH · UNIVERSITY OF COLORADO DENVER · PI WEST, DAVID R. · 2007 to 2010
$1.2M
NIDDK NIH HHS R18 DK067083NIMH NIH HHS MH069809-04NIMH NIH HHS R01 MH069806PHS HHS DF067083
6 · The paper itself

Abstract

purposeWe investigated 3 approaches for implementing the Chronic Care Model to improve diabetes care: (1) practice facilitation over 6 months using a reflective adaptive process (RAP) approach; (2) practice facilitation for up to 18 months using a continuous quality improvement (CQI) approach; and (3) providing self-directed (SD) practices with model information and resources, without facilitation.

methodsWe conducted a cluster-randomized trial, called Enhancing Practice, Improving Care (EPIC), that compared these approaches among 40 small to midsized primary care practices. At baseline and 9 months and 18 months after enrollment, we assessed practice diabetes quality measures from chart audits and Practice Culture Assessment scores from clinician and staff surveys.

resultsAlthough measures of the quality of diabetes care improved in all 3 groups (all P <.05), improvement was greater in CQI practices compared with both SD practices (P <.0001) and RAP practices (P <.0001); additionally, improvement was greater in SD practices compared with RAP practices (P <.05). In RAP practices, Change Culture scores showed a trend toward improvement at 9 months (P = .07) but decreased below baseline at 18 months (P <.05), while Work Culture scores decreased from 9 to 18 months (P <.05). Both scores were stable over time in SD and CQI practices.

conclusionsTraditional CQI interventions are effective at improving measures of the quality of diabetes care, but may not improve practice change and work culture. Short-term practice facilitation based on RAP principles produced less improvement in quality measures than CQI or SD interventions and also did not produce sustained improvements in practice culture.

Indexed as

AgedDiabetes MellitusFamily PracticeFemaleHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePatient-Centered CarePrimary Health CareQuality Improvementdiabetes mellitusfamily medicinepatient-centered medical homepractice-based researchpractice facilitationprimary health carequality improvement

Identifiers

PMID24445098
PMCPMC3896533

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.