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Effectiveness of the chronic care model in type 2 diabetes management in a community health service center in China: a group randomized experimental study
Kong JX, Zhu L, Wang HM, Li Y, Guo AY, Gao C, Miao YY, Wang T, Lu XY, Zhu HH, Patrick DL
Journal of Diabetes Research 2019 Jan 3;(6516581):Epub
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: The Chronic Care Model, based on core elements of team-centered care in chronic diseases, has widely been accepted. This study was aimed at evaluating the effectiveness of the Chronic Care Model in type 2 diabetes management. METHODS: A group randomized experimental study was conducted. Twelve communities of the Zhaohui Community Health Service Center in Hangzhou, China, were randomly assigned into an intervention group (n = 6) receiving the Chronic Care Model-based intervention and a control group (n = 6) receiving conventional care. A total of three hundred patients, twenty-five for each community, aged >= 18 years with type 2 diabetes for at least 1-year duration, were recruited. Data of health behaviors, clinical outcomes, and health-related quality of life (Short-Form 36-item questionnaire) were collected before and after a 9-month intervention and analyzed using descriptive statistics, t-test, chi-square test, binary logistic regression, and linear mixed regression. A total of 258 patients (134 in intervention and 124 in control) who completed the baseline and follow-up evaluations and the entire intervention were included in the final analyses. RESULTS: Health behaviors such as drinking habit (OR 0.07, 95% CI 0.01 to 0.75), physical activity (OR 2.92, 95% CI 1.18 to 7.25), and diet habit (OR 4.30, 95% CI 1.49 to 12.43) were improved. The intervention group had a remarkable reduction in glycated hemoglobin (from 7.17% to 6.60%, p < 0.001). The quality of life score changes of the role limitation due to physical problems (mean 9.97, 95% CI 3.33 to 16.60), social functioning (mean 6.50, 95% CI 2.37 to 10.64), role limitation due to emotional problems (mean 8.06, 95% CI 2.15 to 13.96), and physical component summary score (mean 3.31, 95% CI 1.22 to 5.39) were improved in the intervention group compared to the control group. CONCLUSION: The Chronic Care Model-based intervention helped improve some health behaviors, clinical outcomes, and quality of life of type 2 diabetes patients in China in a short term.

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