Objectives: Action plans based on patient reported outcomes (PROs) made in consultation by adults with type 2 diabetes (T2D) and their health care team have been proposed as a tool to improve clinical outcomes. The aim is to evaluate the quality of action plans.

Methods: A two-arm cluster-randomized trial comparing Connection to Health (CTH) and Enhanced Engagement CTH (EE-CTH) in 12 primary care sites in the San Francisco Bay Area. Adults with T2D filled out a health survey prior to consultation to collect PROs. Action plans made in consultation focused on unhealthy behavior detected by the survey. Providers in EE-CTH were additionally trained in motivational interviewing and relationship building skills. Action plan quality was rated using an adapted version of the GET-D coding system (dual coding of 20%, IRR >80%), and examined for associations with intervention, patient demographics and PROs.

Results: Overall quality of action plans was moderate-high with a mean score of 14.22 (SD=4.07) on a 0-20 quality scale (n=700). Significantly higher quality plans were created in CTH (M=14.87, SD=3.92) compared to EE-CTH (M=13.50, SD=4.12) (t(698)=4.50, p<.001). Correlations with PROs and patient demographics were calculated with Pearson’s (r) or Spearman’s (rs) correlation. Higher patient health literacy and confidence in carrying out the plan were positively related to quality of action plans (rs =.089, p=.018) (rs =.138, p<.001), whereas gender, age, language, race, level of education, depression, and social determinants of health (SDH) were unrelated to action plan quality (p=n.s.).

Discussion: Both CTH and EE-CTH resulted in moderate-high quality action plans, but considerable quality variability was seen across patients. Action plan quality was significantly higher in CTH compared to EE-CTH. Results suggest no link to most patient demographics and PROs. However, health literacy and confidence level are positively related to action plan quality.


P.H. Kjaer: None. M. Dedhia: None. J. Parra: Employee; Self; Behavioral Diabetes Institute. L. Fisher: None. M.B. Potter: None. N. Ejskjaer: None. S.E. Skovlund: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company.


National Institutes of Health (DK108039)

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