Journal of Health & Medical Informatics

Abstract Objectives: This study aims to explore factors that influence progression of Diabetes complications among Medicare non-dual beneficiaries. Three Diabetes complications explored are retinopathy, nephropathy and neuropathy. A second objective of this study is to explore the impact that various patient management programs have on reducing the risk of development of Diabetes complications. Three patient management programs are explored, including total cost of treatment (for payer), total patient cost share and physician factors (rural vs. urban and primary care vs. specialist). Methods: Predictive and descriptive logistic regression models are used with each Diabetes complication as the outcome variable. For predictive models, the risk factors are obtained using stepwise logistics regression. For explanatory models, the risks factors are included with each of the analytical factors in order to risk adjust the impact of the analytical factors on the development of Diabetes complications. Results: Nephropathy is found to be the most predictive of the three Diabetes complications. For nephropathy, both total cost of treatment and total patient cost share show negative statistical relation with nephropathy development. For physician factors, rural and specialist physicians are found to be associated with lower rate of nephropathy development among beneficiaries. Conclusions: There is evidence that prediction and management of Diabetes complications can lead to improved outcomes among Medicare beneficiaries. Total cost of treatment, total patient cost share and physician factors (rural vs. urban and primary care vs. specialist) all appear to play a role in improved outcomes in nephropathy development among beneficiaries.

In theory, conducting robust clinical research is a matter of developing a strong proposal with ethical governance and following through the complete research cycle. However, the reality of design and conducting research is a complicated process involving many opportunities and obstacles that challenge the researcher from start to finish. In this paper we reflect on our experience of conducting our study and how these were responded to and influenced the research. A brief overview of our study’s design and location is provided followed by a pragmatic discussion of the challenges as they arose. An understanding emerged of the critical need to nurture a mutual understanding and strong collaboration between the research team, clinical team and the patient as a key facilitator in completing a research trial