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Quality Improvement Strategies for Type 2 Diabetes—Reply
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In Reply: We appreciate these clarifications from authors of the primary studies included in our analysis. Dr Krein and colleagues clarify that case managers in one1 of their 2 trials1-2 did not make medication changes without approval from primary care physicians. Repeating the random-effects meta-analysis shown in Figure 3 of our article after reclassifying the trial by Krein et al1 increased the pooled reduction in HbA1c levels for the trials in which case managers could make independent medication changes from 0.96% (95% confidence interval, 0.52%-1.41%) to 1.09% (95% confidence interval, 0.71%-1.47%). This relatively small change is because this study contributed only 16% weight to the estimate associated with trials in which case managers could make independent medication changes.
Drs Pignone and DeWalt also bring attention to a misclassification on our part. On reviewing their study3 again, we agree that it could have been coded as including team changes and involving . . . [Full Text of this Article]
Kaveh G. Shojania, MD
kshojania@ohri.ca
Ottawa Health Research Institute
Ottawa, Ontario
Sumant R. Ranji, MD
University of California, San Francisco
Kathryn M. McDonald, MM
Center for Primary Care and Outcomes Research
Stanford University
Palo Alto, Calif
Jeremy M. Grimshaw, MBChB, PhD
Ottawa Health Research Institute
University of Ottawa
Ottawa, Ontario
Robert J. Rushakoff, MD
University of California, San Francisco
Douglas K. Owens, MD, MS
VA Palo Alto Health Care System
Palo Alto, Calif
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Quality Improvement Strategies for Type 2 Diabetes
Sarah L. Krein, Sandeep Vijan, Hae Mi Choe, and Rodney A. Hayward
JAMA. 2006;296(22):2680.
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Quality Improvement Strategies for Type 2 Diabetes
Michael Pignone and Darren DeWalt
JAMA. 2006;296(22):2680-2681.
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