HealthPartners Research Foundation and HealthPartners Medical Group, Minneapolis, Minnesota, USA.
Diabetes Care. 2010 Aug;33(8):1727-33. doi: 10.2337/dc10-0439.
Inexpensive and standardized methods to deliver medical education to primary care physicians (PCPs) are desirable. Our objective was to assess the impact of an individualized simulated learning intervention on diabetes care provided by PCPs.
Eleven clinics with 41 consenting PCPs in a Minnesota medical group were randomized to receive or not receive the learning intervention. Each intervention PCP was assigned 12 simulated type 2 diabetes cases that took about 15 min each to complete. Cases were designed to remedy specific physician deficits found in their electronic medical record observed practice patterns. General linear mixed models that accommodated the cluster randomized study design were used to assess patient-level change from preintervention to 12-month postintervention of A1C, blood pressure, and LDL cholesterol. The relationship between the study arm and the total of intervention and patient health care costs was also analyzed.
Intervention clinic patients with baseline A1C >or=7% significantly improved glycemic control at the last postintervention A1C measurement, intervention effect of -0.19% mean A1C (P = 0.034) and +6.7% in A1C <7% goal achievement (P = 0.0099). Costs trended lower, with the cost per patient -$71 (SE = 142, P = 0.63) relative to nonintervention clinic patients. The intervention did not significantly improve blood pressure or LDL control. Models adjusting for age, sex, and comorbidity showed similar results. PCPs reported high satisfaction.
A brief individualized case-based simulated learning intervention for PCPs led to modest but significant glucose control improvement in adults with type 2 diabetes without increasing costs.
为初级保健医生（PCP）提供医学教育的经济且标准化方法是可取的。我们的目的是评估个体化模拟学习干预对 PCP 提供的糖尿病护理的影响。
明尼苏达州医疗集团的 11 个诊所，共有 41 名同意参与的 PCP 被随机分为接受或不接受学习干预组。每位干预组的 PCP 被分配了 12 个模拟的 2 型糖尿病病例，每个病例大约需要 15 分钟完成。这些病例旨在纠正电子病历中观察到的实践模式中特定医生的不足之处。采用容纳群组随机研究设计的广义线性混合模型，评估 A1C、血压和 LDL 胆固醇从干预前到 12 个月后的患者水平变化。还分析了研究组与干预和患者医疗保健总成本的关系。
基线 A1C≥7%的干预诊所患者在最后一次干预后 A1C 测量中血糖控制显著改善，干预效果为平均 A1C 降低 0.19%（P=0.034），A1C<7%目标的达标率提高 6.7%（P=0.0099）。成本呈下降趋势，与非干预诊所患者相比，每位患者的成本降低了 71 美元（SE=142，P=0.63）。干预并没有显著改善血压或 LDL 控制。调整年龄、性别和合并症的模型显示出相似的结果。PCP 报告了高度的满意度。
针对 PCP 的简短个体化基于病例的模拟学习干预导致 2 型糖尿病成年患者的血糖控制有适度但显著的改善，而不增加成本。
