***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Transition from pediatric to adult diabetes care is a high risk period during which there is an increased rate of disengagement from care . Suboptimal transition has been associated with higher risks for acute and chronic diabetes-related complications . The period of emerging adulthood challenges current systems of healthcare delivery as many young adults with type 1 diabetes ( T1D ) default from diabetes care and are at risk for diabetes complications which are undetected and therefore untreated . Despite the importance of minimizing loss to follow-up there are no r and omized control trials evaluating models of transition from pediatric to adult diabetes care . Methods / Design This is a multicentre r and omized controlled trial . A minimum of 188 subjects with T1D aged between 17 and 20 years will be evaluated . Eligible subjects will be recruited from three pediatric care centres and r and omly assigned in a 1:1 ratio to a structured transition program that will span 18 months or to receive st and ard diabetes care . The structured transition program is a multidisciplinary , complex intervention aim ing to provide additional support in the transition period . A Transition Coordinator will provide transition support and will provide the link between pediatric and adult diabetes care . The Transition Coordinator is central to the intervention to facilitate ongoing contact with the medical system as well as education and clinical support where appropriate . Subjects will be seen in the pediatric care setting for 6 months and will then be transferred to the adult care setting where they will be seen for one year . There will then be a one-year follow-up period for outcome assessment . The primary outcome is the proportion of subjects who fail to attend at least one outpatient adult diabetes specialist visit during the second year after transition to adult diabetes care . Secondary outcome measures include A1C frequency measurement and levels , diabetes related emergency room visits and hospital admissions , frequency of complication screening , and subject perception and satisfaction with care . Discussion This trial will determine if the support of a Transition Coordinator improves health outcomes for this at-risk population of young adults . Trial registration Trial Registration Number : OBJECTIVES Patient contracts are increasingly utilized in medical practice and have the potential to improve health outcomes in high-risk population s. However , as a relatively new tool , there has been limited research regarding the efficacy of patient contracts . Diabetic retinopathy ( DR ) is one of the leading causes of vision impairment in adults in the US and only 50 - 60 % of adults with diabetes adhere to annual dilated fundus exam recommendations . This study aim ed to evaluate the impact of patient contracts on follow-up adherence in diabetic patients with ocular abnormalities after a free , pharmacy-based eye screening . STUDY DESIGN This prospect i ve study implemented a non-invasive , non-mydriatic fundus camera in an urban , community-based pharmacy setting to screen for ocular diseases in patients with diabetes . Patients were assigned to the contract or non-contract group . Patients who signed a contract agreed to : 1 ) review their results with their primary care doctor , 2 ) follow-up with an ophthalmologist if their results were abnormal , and 3 ) inform research staff if/when they completed an eye care appointment . All study participants and their primary care doctors were notified of their results via mail . Follow-up question naires were administered to all patients by telephone three months after the screening results . RESULTS 500 patients were screened and 113 ( 22.6 % ) had abnormal results . Of the patients who had abnormal results , 83 ( 74.3 % ) were able to be contacted . Of the 83 patients who were able to be contacted , the majority of patients were African American ( 73.5 % ) and female ( 56.6 % ) . The mean age was 54.7 years . Of those , 34 ( 41.0 % ) adhered to follow-up recommendations . There was no significant difference in follow-up adherence between the contract ( 38.1 % ) and non-contract group ( 43.9 % ) ( P = 0.59 ) . In addition , 70.4 % of patients did not comply with at least one measure of the contract agreement . CONCLUSION Contracts did not increase follow-up adherence to eye appointments in diabetic patients with ocular abnormalities . The majority of patients did not comply with their contract and follow-up adherence was low in both groups . Most research has yielded mixed results regarding the efficacy of contracts in improving health outcomes . Therefore , different types of contracts or other patient-centered tools should be evaluated in order to increase follow-up adherence in patients at high risk for DR Abstract OBJECTIVE : There is a well-documented gap between diabetes care guidelines and the services received by patients in almost all health care setting s. This project reports initial results from a computer-assisted , patient-centered intervention to improve the level of recommended services received by patients from a wide variety of primary care providers . DESIGN AND SETTING S : Eight hundred eighty-six patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program . Physicians were stratified and r and omized to intervention or control conditions and evaluated on 2 primary outcomes : number of recommended laboratory screenings and recommended patient-centered care activities completed . Secondary outcomes were evaluated using the Problem Areas in Diabetes scale and the Patient Health Question naire (PHQ)-9 depression scale , and the RE- AIM framework was used to evaluate potential for dissemination . RESULTS : The program was well-implemented and significantly improved both number of recommended laboratory assays ( 3.4 vs 3.1 ; P<.001 ) and patient-centered aspects of diabetes care patients received ( 3.6 vs 3.2 ; P<.001 ) compared to those in r and omized control practice s. Activities that were increased most were foot exams ( follow-up rates of 80 % vs 52 % ; P<.003 ) and nutrition counseling ( 76 % vs 52 % ; P<.001 ) . CONCLUSIONS : Patients are very willing to participate in a brief computer-assisted intervention that is effective in enhancing quality of diabetes care . Staff in primary care offices can consistently deliver an intervention of this nature , but most physicians were unwilling to participate in this translation research study OBJECTIVE To evaluate the impact of systematic patient evaluation and patient and provider feedback on the processes and intermediate outcomes of diabetes care in Independent Practice Association model internal medicine practice s. RESEARCH DESIGN AND METHODS Nine practice s providing care to managed care patients were r and omly assigned as intervention or comparison sites . Intervention-site subjects had Annual Diabetes Assessment Program ( ADAP ) assessment s ( HbA(1c  ) , blood pressure , lipids , smoking , retinal photos , urine microalbumin , and foot examination ) at years 1 and 2 . Comparison-site subjects had ADAP assessment s at year 2 . At Intervention sites , year 1 ADAP results were review ed with subjects , mailed to providers , and incorporated into electronic medical records with guideline -generated suggestions for treatment and follow-up . Medical records were evaluated for both groups for the year before both the year 1 and year 2 ADAP assessment s. Processes and intermediate outcomes were compared using linear and logistic mixed hierarchical models . RESULTS Of 284 eligible subjects , 103 of 173 ( 60 % ) at the Intervention sites and 71 of 111 ( 64 % ) at the comparison sites participated ; 83 of 103 ( 81 % ) of the intervention-site subjects returned for follow-up at year 2 . Performance of the six recommended assessment s improved in intervention-site subjects at year 2 compared with year 1 ( 5.8 vs. 4.3 , P = 0.0001 ) and compared with comparison-site subjects at year 2 ( 4.2 , P = 0.014 ) . No significant changes were noted in intermediate outcomes . CONCLUSIONS The ADAP significantly improved processes of care but not intermediate outcomes . Additional interventions are needed to improve intermediate outcomes BACKGROUND In the Medicare Modernization Act of 2003 , Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program . METHODS The Medicare Health Support Pilot Program was a large , r and omized study of eight commercial programs for disease management that used nurse-based call centers . We r and omly assigned patients with heart failure , diabetes , or both to the intervention or to usual care ( control )  and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care , acute care utilization , and Medicare expenditures for Medicare fee-for-service beneficiaries . RESULTS The study included 242,417 patients ( 163,107 in the intervention group and 79,310 in the control group ) . The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits , as compared with usual care . We observed only 14 significant improvements in process-of-care measures out of 40 comparisons . These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ( $ 400 million ) , with no demonstrable savings in Medicare expenditures . CONCLUSIONS In this large study , commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality -of-care measures , with no demonstrable reduction in the utilization of acute care or the costs of care Background and objectives Many clinical management guidelines for chronic diseases have been published , but they have not been put into practice by busy clinicians at primary care levels . This study evaluates the implementation of national guidelines incorporated within a structured diabetes and hypertension clinical record ( SR ) in Cape Town in a r and omised controlled trial ( RCT ) . Methods Eighteen public sector community health centres ( CHC ) were r and omly selected and allocated as intervention or control CHC . At each clinic , 25 patients with diabetes and 35 patients with hypertension were enrolled at baseline . Question naires were completed , blood sample s were collected , blood pressure ( BP ) and anthropometric measures were taken and patient records were audited . SR with clinical guideline prompts were introduced at the intervention clinics after training doctors in their use and suggestions to incorporate them in regular patient records . Contact was maintained during the year of intervention with the clinic staff . A follow-up survey was conducted 1 year later to assess BP and HbA1c , and the patient records were examined to ascertain the extent of use of the SR in the intervention clinics . In-depth interviews were conducted with doctors and nurses to record their response to the intervention . Results The intervention evaluated in this RCT had no impact on either diabetes or hypertension control . In the intervention clinics , less than 60 % of the patient folders contained the SR and when present was seldom used . Although the staff were well disposed to the research team , their workload prohibited them from undertaking a true evaluation of the SR , and overall they did not perceive the SR as supporting their current process of patient care . Conclusions No benefit to diabetes of hypertension care by introducing and availability of the staff in the use of the SR was shown in this RCT . The process measures suggest that the SR was not widely used by the healthcare provided in the primary care clinics OBJECTIVE —The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practice s. RESEARCH DESIGN AND METHODS —This was a group-r and omized , controlled clinical trial evaluating the practical effectiveness of a multicomponent intervention ( TRANSLATE )  in 24 practice s. The intervention included implementation of an electronic diabetes registry , visit reminders , and patient-specific physician alerts . A site coordinator facilitated previsit planning and a monthly review of performance with a local physician champion . The principle outcomes were the percentage of patients achieving target values for the composite of systolic blood pressure ( SBP ) < 130 mmHg , LDL cholesterol < 100 mg/dl , and A1C < 7.0 % at baseline and 12 months . Six process measures were also followed . RESULTS —Over 24 months , 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practice s from 17 health systems .  Diabetes process measures increased significantly more in intervention than in control practice s , giving net increases as follows : foot examinations 35.0 % ( P < 0.0.001 ) ; annual eye examinations 25.9 % ( P < 0.001 ) ; renal testing 28.5 % ( P < 0.001 ) ; A1C testing 8.1%(P < 0.001 ) ; blood pressure monitoring 3.5 % ( P = 0.05 ) ; and LDL testing 8.6 % ( P < 0.001 ) . Mean A1C adjusted for age , sex , and comorbidity decreased significantly in intervention practice s ( P < 0.02 ) . At 12 months , intervention practice s had significantly greater improvement in achieving recommended clinical values for SBP , A1C , and LDL than control clinics ( P = 0.002 ) . CONCLUSIONS — Introduction of a multicomponent organizational intervention in the primary care setting significantly increases the percentage of type 2 diabetic patients achieving recommended clinical outcomes BACKGROUND Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness . METHODS The authors conducted a r and omized , controlled trial comparing telemedicine case management to usual care , with blinding of those obtaining outcome data , in 1,665 Medicare recipients with diabetes , aged 55 years or greater , and living in 
    Output:
    
Both DRS-targeted ( RD 0.17 , 95 % CI 0.11 to 0.22 ) and general QI interventions ( RD 0.12 , 95 % CI 0.09 to 0.15 ) were effective , particularly where baseline DRS attendance was low .
All BCT combinations were associated with significant improvements , particularly in those with poor attendance .
Overall , we found that there is insufficient evidence to draw robust conclusions about the relative cost effectiveness of the interventions compared to each other or against usual care .
The results of this review provide evidence that QI interventions targeting patients , healthcare professionals or the healthcare system are associated with meaningful improvements in DRS attendance compared to usual care .
There was no statistically significant difference between interventions specifically aim ed at DRS and those which were part of a general QI strategy for improving diabetes care .
This is a significant finding , due to the additional benefits of general QI interventions in terms of improving glycaemic control , vascular risk management and screening for other microvascular complications .
It is likely that further ( but smaller ) improvements in DRS attendance can also be achieved by increasing the intensity of a particular QI component or adding further components