Educational toolkit does not improve quality of care or cardiovascular outcomes in patients with diabetes: ICES study

04/02/2014

Printed education materials are one of the most commonly used approaches for quality improvement but according to a study by researchers at the Institute for Clinical Evaluative Sciences (ICES), education toolkits do not improve quality of care or cardiovascular outcomes in patients with diabetes — they may make them worse.

The study, published today in the journal PLOS Medicine, is the largest-ever randomized trial in diabetes. It evaluated the effectiveness of an educational toolkit focusing on cardiovascular disease screening and risk reduction in people with diabetes.

“Even though printed educational materials were relatively easy and inexpensive to implement, they were not effective. In fact the possibility that the intervention might have worsened care is unexpected,” said Baiju Shah, lead author and scientist at ICES.

Nearly one million people (933,789) aged 40 or under with diagnosed diabetes in Ontario were studied. Family practices were randomly assigned to receive the educational toolkit in June 2009 (intervention group) or May 2010 (control group). The study found:

Death or non-fatal heart attack, occurred in 11,736 (2.5 per cent) patients in the intervention group and 11,536 (2.5 per cent) in the control group
Use of a statin, occurred in 700 (88.1 per cent) patients in the intervention group and 725 (90.1 per cent) in the control group

“The cardiovascular disease management toolkit failed to reduce clinical events or improve quality of care for patients with diabetes. Despite years of evidence that printed educational materials have, at best, only a modest impact on quality of care, they remain a very commonly-used intervention for quality improvement,” added Shah.

The authors suggest that even the remote potential for the toolkit to cause true harm is worrying, as the health consequences across the whole population could be significant. The authors stress the results of this study highlight the need for a rigorous and scientifically-based approach to the development, dissemination and evaluation of quality improvement interventions.

“These research findings align with our new strategy for the dissemination and implementation of the 2013 Clinical Practice Guidelines, independently and widely recognized as an evidence-based resource in the prevention and management of diabetes,” says Dr. Jan Hux, chief science officer of the Canadian Diabetes Association. “Our new healthcare provider and patient tools – designed by healthcare practitioners – have expanded beyond paper to include a number of interactive electronic resources, available at guidelines.diabetes.ca.”

Authors: BR Shah, O Bhattacharyya, CHY Yu, MM Mamdani, JA Parsons, SE Straus and M Zwarenstein.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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