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Gestational diabetes: Comparing treatment options

Comparative effectiveness research is a big term for a simple idea. How do health care providers like Kaiser Permanente decide which treatment for a problem is best?

The National Institutes of Health, as part of its goal to help health care providers do a better job of keeping costs down and quality of care up, looks for good comparative effectiveness research to fund. The gestational diabetes project of Assiamira Ferrara, MD, PhD, made the cut.

Her study will compare two ways to help women with gestational diabetes lose the weight they gain during pregnancy and keep it off, and will evaluate which one is more cost-effective.

That’s the comparative effectiveness part: Is the new treatment more effective, and if it is, is its additional cost outweighed by the improved health of the women helped by it?

Kaiser Permanente strength: many local sites
Dr. Ferrara’s team decided to include 2,500 pregnant women in their study. Half will be in the “usual care” group, receiving the usual treatment. The others will be in the “intervention” group, receiving the new diabetes prevention program by telephone.

Most studies of this kind would randomly assign individual participants to each group. But because this study evaluates how a real world health care system provides care, Dr. Ferrara’s team chose to turn that around by randomly assigning Kaiser Permanente medical facilities, either to be a usual care site or to be an intervention site.

Her team — under the direction of Charles Quesenberry, PhD, the team’s biostatistician — will assign each of 44 Kaiser Permanente Northern California facilities to one of two groups: usual care or intervention treatment.

All the pregnant women visiting a facility, like the Oakland Medical Center or the Petaluma medical offices, will receive the same treatment. This is known as a cluster randomized study and it takes full advantage of a Kaiser Permanente strength, its many local medical facilities.

Offering the same treatment to all participating women at each facility is not only easier, but also helps the clinic they visit operate more consistently, more like the real world.

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