• Thomas A Mackey, Frank L Cole, and Julie Lindenberg.
• UT Health Services, University of Texas Health Science Center at Houston, TX, USA. thomas.a.mackey@uth.tmc.edu
• J Am Acad Nurse Prac. 2005 Dec 1; 17 (12): 547-53.

PurposeTo examine a set of system interventions in the management of patients with diabetes and the outcomes of their care.Data SourcesPreintervention and postintervention data collected from electronic medical records.ConclusionsThe sample size was smaller than expected, contributing to a lack of statistical significance from preintervention to postintervention in the patient outcome measures. The systems-level variables that were under the direct control of the clinic staff (e.g., pneumococcal vaccine given) showed great improvement. In the preintervention period, the percentage of "yes" responses to the system-level variables ranged from 8 to 24 and jumped to 16 to 95 after the intervention.Implications For PracticeUnequivocally, this project demonstrated that systems-level changes result in improved care being provided to patients; however, these had minimal impact on the patient outcome variables. Promoting change in patient behavior is difficult, which may have contributed to the lack of significance in this area, while the variables under the direct control of the clinic staff were more easily changed.

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