Journal of general internal medicine · 2026
Videographic Analysis of an Intervention to Improve Patient-Centered Care for People Living with Type 2 Diabetes: The QBSAFE Randomized Trial.
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Montori V Victor, Larios Felipe, Bandi Satya Sai Sri, Proano Ana Cristina, Guevara Kerly, Vilatuna Luis, Bagewadi Shubhangi, van Gastel Anka, Branda Megan E, Camp Anne W, Montosa Mel, McCoy Rozalina G, Montori Victor M, Lipska Kasia J
Аннотация
BACKGROUND: Clinical encounters between people living with type 2 diabetes and their primary care clinicians often emphasize metabolic control over self-management concerns.
OBJECTIVE: To determine whether QBSAFE cards were used as intended, their effect on the topics of discussion, and whether they enabled clinicians to notice and respond to patients' situations.
DESIGN: At a federally qualified primary care clinic, participants were randomly assigned to usual care with or without QBSAFE cards. Visits were video recorded.
PARTICIPANTS: Eleven clinicians and 155 of their patients with diabetes and HbA1c > 8%.
INTERVENTION: Fourteen QBSAFE cards addressing issues related to quality of life, burden of treatment, safety, and prevention of diabetes complications.
MAIN MEASURES: Eight trained reviewers analyzed videos using a structured codebook to capture encounter characteristics, assess fidelity, and to record domain-specific discussions and degree of clinician responsiveness to issues raised by patients.
KEY RESULTS: Of 143 eligible encounters (12 of 155 were found to have HbA1c ≤ 8% post-randomization), 137 (65 usual care, 72 QBSAFE) yielded evaluable videos. QBSAFE cards were used as intended in 61 (85%) QBSAFE arm encounters. Compared to usual care, conversations about burden of treatment related to nonpharmacological interventions (17 vs 33, OR 2.38, 95% CI 1.11-5.12) and to taking medications (11 vs 33, OR 4.29, 95% CI 1.78-10.37) and about the patient's challenging environment (2 vs 10, OR 5.08, 95% CI 1.05-24.50) were more prevalent in the QBSAFE arm. There were no between-arm differences in metabolic control discussions or new care plans or in encounter duration. QBSAFE encounters were more likely to be considered unhurried.
CONCLUSIONS: QBSAFE cards led to small patient-centered changes to encounter conversations, promoting ones about treatment burden, without displacing metabolic control discussions. Future work will focus on assisting clinicians in responding more effectively to patient issues so that raising these could change plans of care.
TRIAL REGISTRATION: ClinicalTrials.gov NCT05553912, registered 9/21/2022.
OBJECTIVE: To determine whether QBSAFE cards were used as intended, their effect on the topics of discussion, and whether they enabled clinicians to notice and respond to patients' situations.
DESIGN: At a federally qualified primary care clinic, participants were randomly assigned to usual care with or without QBSAFE cards. Visits were video recorded.
PARTICIPANTS: Eleven clinicians and 155 of their patients with diabetes and HbA1c > 8%.
INTERVENTION: Fourteen QBSAFE cards addressing issues related to quality of life, burden of treatment, safety, and prevention of diabetes complications.
MAIN MEASURES: Eight trained reviewers analyzed videos using a structured codebook to capture encounter characteristics, assess fidelity, and to record domain-specific discussions and degree of clinician responsiveness to issues raised by patients.
KEY RESULTS: Of 143 eligible encounters (12 of 155 were found to have HbA1c ≤ 8% post-randomization), 137 (65 usual care, 72 QBSAFE) yielded evaluable videos. QBSAFE cards were used as intended in 61 (85%) QBSAFE arm encounters. Compared to usual care, conversations about burden of treatment related to nonpharmacological interventions (17 vs 33, OR 2.38, 95% CI 1.11-5.12) and to taking medications (11 vs 33, OR 4.29, 95% CI 1.78-10.37) and about the patient's challenging environment (2 vs 10, OR 5.08, 95% CI 1.05-24.50) were more prevalent in the QBSAFE arm. There were no between-arm differences in metabolic control discussions or new care plans or in encounter duration. QBSAFE encounters were more likely to be considered unhurried.
CONCLUSIONS: QBSAFE cards led to small patient-centered changes to encounter conversations, promoting ones about treatment burden, without displacing metabolic control discussions. Future work will focus on assisting clinicians in responding more effectively to patient issues so that raising these could change plans of care.
TRIAL REGISTRATION: ClinicalTrials.gov NCT05553912, registered 9/21/2022.