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

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 = 0.001), 2) checklists of tests or interventions needed for prevention or monitoring of diabetes (P = 0.002), and 3) physician reminders of guideline-based age-appropriate risk assessments due at the patient visit (P = 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.




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Asparagus with sea butter and rosemary

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by Dan Hunter, chef and owner of Otways' restaurant Brae.




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Interdisciplinary Team Care for Diabetic Patients by Primary Care Physicians, Advanced Practice Nurses, and Clinical Pharmacists

David Willens
Apr 1, 2011; 29:60-68
Feature Articles




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Insulin Strategies for Primary Care Providers

Karen L. Herbst
Jan 1, 2002; 20:
Feature Articles




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Standards of Medical Care in Diabetes--2019 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2019; 37:11-34
Position Statements




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Standards of Medical Care in Diabetes--2016 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2016; 34:3-21
Position Statements




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A Real-World Approach to Insulin Therapy in Primary Care Practice

Irl B. Hirsch
Apr 1, 2005; 23:78-86
Practical Pointers




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Standards of Medical Care in Diabetes--2018 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2018; 36:14-37
Position Statements




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Standards of Medical Care in Diabetes--2017 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2017; 35:5-26
Position Statements




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Standards of Medical Care in Diabetes--2015 Abridged for Primary Care Providers

American Diabetes Association
Apr 1, 2015; 33:97-111
Position Statements




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How you can help save the monarch butterfly -- and the planet | Mary Ellen Hannibal

Monarch butterflies are dying at an alarming rate around the world -- a looming extinction that could also put human life at risk. But we have just the thing to help save these insects, says author Mary Ellen Hannibal: citizen scientists. Learn how these grassroots volunteers are playing a crucial role in measuring and rescuing the monarch's dwindling population -- and how you could join their ranks to help protect nature. (You'll be in good company: Charles Darwin was a citizen scientist!)




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Ohio primary voters approved fewer school tax issues




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Ohio primary voters approved fewer school tax issues




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'It's Our Time': Maryland Teachers March for School Funding

Thousands of teachers marched in Annapolis on Monday evening, pushing for higher pay and more resources for their students.




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Audit: Maryland Dept. Did Not Properly Store Data for 1.4 Million Students

The Maryland State Department of Education "inappropriately stored" personal information of 1.4 million students and more than 230,000 teachers, leaving them vulnerable to potential bad actors, according to an audit published earlier this month.




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Educational Opportunities and Performance in Maryland

This Quality Counts 2019 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Maryland Ranks Fourth on Quality Counts Annual Report Card

The state, which earned a B, saw its educational strength buoyed by strong performance in areas that measure socioeconomic factors that can affect the educational environment.




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Here's Why a Maryland School Finance Overhaul Could Prove Groundbreaking

Maryland's legislature has proposed a unique way to fund schools and also wants to hold school districts more accountable for how they spend their money as part of a new funding formula.




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Educational Opportunities and Performance in Maryland

This Quality Counts 2020 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Maryland extends school closings through May 15 due to virus




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Maryland educators, students aim to adapt to closures




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Ohio primary voters approved fewer school tax issues




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Maryland among three finalists for top 2021 QB recruit Caleb Williams

Mike Locksley and the Terrapins are making a push for local five-star Caleb Williams.




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Former Maryland coach Roy Lester dies after contracting coronavirus

Lester coached at Maryland from 1969-71. He was 96.




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Roy Lester, former Maryland football coach, dies at 96

Roy Lester, who sandwiched a disappointing three-year stint as Maryland's football coach between a highly successful career at the high school level, has died. Lester's daughter, Amy Lester Greco, said on a Facebook post that her father died Sunday in Rockville, Maryland, due to complications from the new coronavirus. Lester made a name for himself in Maryland during a 10-year run at Richard Montgomery High School in Rockville during which the Rockets went unbeaten six times and had an 86-10-1 record.




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Basin salinity management 2030 : summary report 2017-18.




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Silence is consent / Rosemary Winderlich.




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Probate rules : preparing grants of probate & letters of administration / paper presented by Rosemary Caruso, Tindall Gask Bentley.




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Probate rules : preparing grants of probate & letters of administration / paper presented by Rosemary Caruso, Tindall Gask Bentley.




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Minister's performance assessment report Water plan (Mary Basin) 2006 / compiled by Water Policy and Water Services (South Region) - Department of Natural Resources, Mines and Energy.

This report provides an overview of the implementation of the Water plan (Mary Basin) 2006 and summarises the findings of the assessments undertaken for the last five years. The plan supports urban water supply and a variety of industries including significant agricultural production, a growing tourism industry and fisheries.




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Ratings summary - labour market analysis of skilled occupations / Department of Employment, Skills, Small and Family Business.




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Interim technical report : project 3.1 : lower cost, more effective 3D seismic exploration for hard rock environments : seismic exploration for mineral deposits case study summary table / authors: Milovan Urosevic, Andrej Bona.

"This document is intended to summarise the current state, understanding and the use of seismic reflection method for mineral exploration. Its primary objective is to provide a point of reference, based on actual case studies, for mineral explorers interested in the application of seismic methods to their project. It provides summary information (including the purpose of the survey, acquisition methods, geometry and cost, processing procedures and key findings) that are intended to provide the reader with an objective means of assessing the cost effectiveness of the technique with respect to exploration objectives. It is also aimed at exchange of information between DETCRC sponsors, affiliates and researchers. Finally we hope that this table will help in shaping future research efforts and direction within Project 3.1, regarding the application of seismic for mineral exploration.This is only initial work and it is hoped that it will evolve into a document or a catalogue that will be extensively used by the mineral industry to achieve their exploration objectives in more efficient and effective way" -- Executive summary.




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Women & power : a manifesto / Mary Beard.

Feminism.




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How do we look? : the eye of faith / Mary Beard.

Faith.




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Struggling to Stay Connected on Maryland’s Eastern Shore as Teaching Moves Online

As teachers across the country grapple with the challenges that come with remote learning due to the coronavirus pandemic, an elementary school teacher on Maryland’s Eastern Shore faces the added challenge of a lack of internet access at home. 




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Edinburgh and District Water Bill. St. Mary's Loch scheme. Speeches of Bailie Lewis, convener of works committee, Edinburgh and District Water Trust, at the meetings of town council, on 30th May and 1st June, 1871.

[Edinburgh] : [publisher not identified], [1871]




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The effect of the cold weather in the early part of 1895 on the admission of medical cases into the Royal Edinburgh Infirmary. With a note on some earlier periods of severe weather / by A. Lockhart Gillespie.

London : Kenny & Co, [1895?]




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The life of Thomas Wills, F.C.S. : demonstrator of chemistry, Royal Naval College, Greenwich / by his mother, Mary Wills Phillips, and her friend, J. Luke.

London : James Nisbet & Co., MDCCCLXXX [1880]




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The dynastic marriage of William of Orange and Mary Stuart: above, they are brought together before a bust of Hercules; below, their wedding in London on 4 November 1677. Etching by R. de Hooghe, 1678.

[The Netherlands] : [Romeyn de Hooghe?], [1678?]




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Tuberculosis statistics : summary of the report / addressed by Dr. S. Rosenfeld (Vienna) to the Health Committee of the Leage of Nations.

England : League of Nations, 1925.




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Professional and paraprofessional drug abuse counselors : three reports / Leonard A. LoSciuto, Leona S. Aiken, Mary Ann Ausetts ; [compiled, written, and prepared for publication by the Institute for Survey Research, Temple University].

Rockville, Maryland : National Institute on Drug Abuse, 1979.




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Family therapy : a summary of selected literature.

Rockville, Maryland : National Institute on Drug Abuse, 1980.




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Primary care for older adults : models and challenges

9783319613291




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Measuring human activity spaces from GPS data with density ranking and summary curves

Yen-Chi Chen, Adrian Dobra.

Source: The Annals of Applied Statistics, Volume 14, Number 1, 409--432.

Abstract:
Activity spaces are fundamental to the assessment of individuals’ dynamic exposure to social and environmental risk factors associated with multiple spatial contexts that are visited during activities of daily living. In this paper we survey existing approaches for measuring the geometry, size and structure of activity spaces, based on GPS data, and explain their limitations. We propose addressing these shortcomings through a nonparametric approach called density ranking and also through three summary curves: the mass-volume curve, the Betti number curve and the persistence curve. We introduce a novel mixture model for human activity spaces and study its asymptotic properties. We prove that the kernel density estimator, which at the present time, is one of the most widespread methods for measuring activity spaces, is not a stable estimator of their structure. We illustrate the practical value of our methods with a simulation study and with a recently collected GPS dataset that comprises the locations visited by 10 individuals over a six months period.




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Experience-Dependent Plasticity of Binocular Responses in the Primary Visual Cortex of the Mouse

Joshua A. Gordon
May 15, 1996; 16:3274-3286
Articles




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Linearity and Normalization in Simple Cells of the Macaque Primary Visual Cortex

Matteo Carandini
Nov 1, 1997; 17:8621-8644
Articles




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Mary Elizabeth Williams: The clumsy, beautiful Rally to Restore Sanity




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Streaming of Repeated Noise in Primary and Secondary Fields of Auditory Cortex

Statistical regularities in natural sounds facilitate the perceptual segregation of auditory sources, or streams. Repetition is one cue that drives stream segregation in humans, but the neural basis of this perceptual phenomenon remains unknown. We demonstrated a similar perceptual ability in animals by training ferrets of both sexes to detect a stream of repeating noise samples (foreground) embedded in a stream of random samples (background). During passive listening, we recorded neural activity in primary auditory cortex (A1) and secondary auditory cortex (posterior ectosylvian gyrus, PEG). We used two context-dependent encoding models to test for evidence of streaming of the repeating stimulus. The first was based on average evoked activity per noise sample and the second on the spectro-temporal receptive field. Both approaches tested whether differences in neural responses to repeating versus random stimuli were better modeled by scaling the response to both streams equally (global gain) or by separately scaling the response to the foreground versus background stream (stream-specific gain). Consistent with previous observations of adaptation, we found an overall reduction in global gain when the stimulus began to repeat. However, when we measured stream-specific changes in gain, responses to the foreground were enhanced relative to the background. This enhancement was stronger in PEG than A1. In A1, enhancement was strongest in units with low sparseness (i.e., broad sensory tuning) and with tuning selective for the repeated sample. Enhancement of responses to the foreground relative to the background provides evidence for stream segregation that emerges in A1 and is refined in PEG.

SIGNIFICANCE STATEMENT To interact with the world successfully, the brain must parse behaviorally important information from a complex sensory environment. Complex mixtures of sounds often arrive at the ears simultaneously or in close succession, yet they are effortlessly segregated into distinct perceptual sources. This process breaks down in hearing-impaired individuals and speech recognition devices. By identifying the underlying neural mechanisms that facilitate perceptual segregation, we can develop strategies for ameliorating hearing loss and improving speech recognition technology in the presence of background noise. Here, we present evidence to support a hierarchical process, present in primary auditory cortex and refined in secondary auditory cortex, in which sound repetition facilitates segregation.




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The Myth of 'Bloody Mary'

History remembers the English queen as a murderous monster, but the real story of Mary I is far more nuanced




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TeenStreet 2019 Summary

How do you encapsulate everything that goes into a full week of teaching, worship music, workshops, meals and so much more? Enjoy a brief overview of TeenStreet 2019.