BACKGROUND/RATIONALE:
More than 800,000 patients with diabetes receive care through the Department of Veterans Affairs (VA). The Translating Research into Action in the Department of Veterans Affairs (TRIAD-VA) study, conducted in collaboration with the Centers for Disease Control and Prevention (CDC), was designed to benchmark VA care with commercial managed care, using equivalent measures developed for the CDC-TRIAD study, and to begin to examine organizational factors that contribute to differences in quality. Our results from TRIAD-VA demonstrated that diabetes processes of care were better for VA patients than commercial managed care patients, however, there was still significant potential for improvement in intermediate outcomes, particularly blood pressure control. (AIM, Kerr, 2004) This suggested that further quality improvement and monitoring mechanisms need to be instituted in both VA and commercial plans to improve treatment modalities likely to affect intermediate outcomes.

OBJECTIVE(S):
The purpose of this planning study is to determine the feasibility of continuing our collaboration with the CDC in a second phase of the TRIAD study (TRIAD-VA 2) and specifically to address the following objectives: 1) To evaluate the TRIAD-CDC process of tracking and adjudicating specific clinical endpoints in VA, such as stroke and myocardial infarction, to ensure that comparability can be achieved before undertaking a more extensive study comparing rates of clinical endpoints in VHA and in commercial managed care organizations; 2) To determine the retention rate of the existing TRIAD-VA cohort of patients for longer-term follow-up; 3) To collect longitudinal data for this diabetes cohort that will allow us to more fully assess intensity of clinical treatment for hyperglycemia, hyperlipidemia and hypertension as well as examine access to care and resource utilization related issues; and, 4) To continue our collaboration with the CDC and the CDC-funded TRIAD investigators and demonstrate that we are able to actively participate in the planning process and ensure that VA relevant goals and objectives are included as part of a multi-year collaborative TRIAD 2 study.

METHODS:
During the planning study, we are re-contacting our baseline TRIAD-VA cohort and collecting important information on diabetes complications that patients have experienced during the previous 2-3 years using mailed surveys. We are also asking patients for consent to review their administrative and medical record data. For those who re-consent, we will examine changes in quality of care over time and examine hospitalizations for stroke or MI in order to test the method developed by the TRIAD-CDC investigators for verifying clinical outcomes. Data analyses, for the purpose of establishing the feasibility of continuing the collaboration with the CDC, will be primarily descriptive in nature.

FINDINGS/RESULTS:
Of the original 1,694 subjects, 1,050 provided informed consent for the study and 1,043 completed the events survey. 196 were reported deceased since TRIAD-VA, 38 have declined further participation, and 1 person has withdrawn from the study.

IMPACT:
Findings from TRIAD-VA 2 planning study will provide information on whether a full TRIAD-2 study is feasible, and will allow us to collect longitudinal data on this cohort of patients to assess the correlates of longer-term diabetes complications in VA

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Kerr EA, Gerzoff RB, Krein SL, Selby JV, Piette JD, Curb JD, Herman WH, Marrero DG, Narayan KM, Safford MM, Thompson T, Mangione CM. Diabetes care quality in the Veterans Affairs Health Care System and commercial managed care: the TRIAD study. Annals of internal medicine. 2004 Aug 17; 141(4):272-81. [view]

DRA: Health Systems
DRE: none
Keywords: Managed care, Organizational issues, VA/non-VA comparisons
MeSH Terms: none