Redesigning Primary Care to Improve Diabetes Outcomes (the UNITED Study)

Kevin A Peterson, Caroline Carlin, Leif I Solberg, Rachel Jacobsen, Toni Kriel, Milton Eder

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


OBJECTIVE The effective redesign of primary care delivery systems to improve diabetes care requires an understanding of which particular components of delivery consistently lead to better clinical outcomes. We identified associations between common systems of care management (SysCMs) and the frequency of meeting standardized performance targets for Optimal Diabetes Care (NQF#0729) in primary care practices. RESEARCH DESIGN AND METHODS A validated survey of 585 eligible family or general internal medicine practices seeing ‡30 adult patients with diabetes in or near Minnesota during 2017 evaluated the presence of 62 SysCMs. From 419 (72%) practices completing the survey, NQF#0729 was determined in 396 (95%) from electronic health records, including 215,842 patients with type 1 or type 2 diabetes. RESULTS Three SysCMs were associated with higher rates of meeting performance targets across all practices: 1) a systematic process for shared decision making with patients (P 5 0.001), 2) checklists of tests or interventions needed for prevention or monitoring of diabetes (P 5 0.002), and 3) physician reminders of guideline-based age-appropriate risk assessments due at the patient visit (P 5 0.002). When all three were in place, an additional 10.8% of the population achieved recommended performance measures. In subgroup analysis, 15 additional SysCMs were associated with better care in particular types of practices. CONCLUSIONS Diabetes care outcomes are better in primary care settings that use a patient-centered approach to systematically engage patients in decision making, remind physicians of age-appropriate risk assessments, and provide checklists for recommended diabetes interventions. Practice size and location are important considerations when redesigning delivery systems to improve performance.

Original languageEnglish (US)
Pages (from-to)549-555
Number of pages7
JournalDiabetes care
Issue number3
Early online dateDec 27 2019
StatePublished - Mar 1 2020

Bibliographical note

Funding Information:
Routine support of self-management for patients and their families through an interactive Web site sponsored by one’s organization (D20)

Funding Information:
Funding. Research reported in this article was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number R18-DK-110732.

Publisher Copyright:
© 2019 by the American Diabetes Association.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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