Journal of evaluation in clinical practice
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The objective of the Mayo Health System Diabetes Translation Project is to assess the impact of three different models of care on the overall quality of diabetes care in the community. The unit of study is the primary care practice with a different model of care implemented at each of three sites. The design incorporates a comparison of a diabetes guideline implementation team initiative (Practice model A), a guideline initiative combined with clinical use of a Diabetes Electronic Management System (DEMS) by primary care providers (Practice model B) and a guideline initiative combined with DEMS utilization combined with electronic review of DEMS patient encounters by an endocrinologist (Practice model C). ⋯ Baseline data revealed significant differences across sites in adherence to certain key indicators of the quality of diabetes care including: frequency of documentation of eye examinations (19, 39 and 37% for sites A, B and C, respectively), haemoglobin A1c monitoring (64, 89 and 77%) and microalbumin monitoring (3, 15 and 6%). The interventions being assessed in this study include traditional (diabetes education; guideline implementation) and modern (DEMS; telemedicine specialist review) methods for improving the quality of diabetes care. In spite of variation in baseline quality indicators, the setting and design should lead to broad applicability of the results and help determine an optimal model of diabetes care in the community.
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This paper examines conflict of interest as it may arise in the activities of research advisory committees and ethical review committees. It distinguishes between vested interests and true conflict of interest. It also examines the ways in which stakeholdings differ from vested interests and conflicting interests differ from conflicts of interest. ⋯ The more these interests diverge, the more opportunity will arise for conflict of interest. These observations have implications for the constitution of research advisory and ethical review committees, and the ways in which their discussions are conducted. Some practical help with protocols of discussion can be gained from philosophical and management writings.