OF THE PROJECT: The Kaiser Permanente Northern California (KPNC)'s Division of Research proposes to continue participation in the TRIAD Study through its Legacy FOA. TRIAD has proven many new insights into how both system and patient factors influence the quality and outcomes of diabetes care in health systems. Many "second generation" questions have been raised and the TRIAD datasets allow for study of some of these questions. The KPNC team (Drs. Selby, Karter, Ferrara, and Schmittdiel) all hope to remain involved during TRIAD and have each contributed to the six paper proposals included. These proposals focus squarely on advancing our understanding of health disparities in these insured populations. They examine both system and patient factors as potential determinants of disparities. Two proposals examine the potential effects of system-level interventions (mail order pharmacy (#3) and incentives to use mail order pharmacy (#1)) on patient behaviors and outcomes, with specific attention to differences by race/ethnicity and socioeconomic status. Two proposals (#'s 4 and 6) look at patient factors (i.e., weight gain) and how differential weight gain in persons with diabetes and women with gestational diabetes affects patterns of disparities in CVD risk factor levels. One proposal (#5) looks at a physician factor, the awareness of medication non-adherence, by primary care physicians. The final proposal (#2) is a methodologic inquiry into the mechanisms of health disparities. The KPNC TRIAD investigator team has proven its engagement with TRIAD by first-authoring 16 of TRIAD's 64 papers, and by making additional KPNC data available to colleagues from other TRCs for site specific projects (e.g., Mail Order Pharmacy Project, Medicare Part D Project, Insulin Starts Project). The team hopes to pursue our paper proposals and those proposed from other TRIAD TRCs in the same collaborative fashion that TRIAD has established, to continue participating on (and continuing to chair, if requested) the Steering Committee. It is also committed to preserving and practicing secure data sharing of the previously collected TRIAD data and to disseminating study findings back to the health systems that provided the data as well as to the scientific community through publications and presentations.
Kaiser Permanente's TRIAD Translational Research Center team proposes to continue studying the datasets that were built as part of TRIAD to further our understanding of how health care system characteristics and activities affect the quality and outcomes of care for patients with diabetes. Of special interest are the differences (disparities) TRIAD has observed in outcomes or quality of care between persons of differing race/ethnicity, gender, socioeconomic status and age. The project team has proposed six additional analyses to further our understanding of disparities in control of the major risk factors for complications across race/ethnicity, socioeconomic status, and gender.