OF THE PROJECT: This application presents 6 analyses proposals that utilize data collected as part of the TRIAD study between 2000 and 2006. TRIAD is a multicenter prospective cohort study. It includes data collected at baseline (round 1) from approximately 12,000 individuals during 2000-2001, follow-up data (round 2) collected 18-months later from approximately 9,000 of the original participants during 2002-2003, and a second follow-up (round 3) collected data from approximately 6,000 individuals of the original cohort of participants during 2005. Data were also collected from health plans, provider groups, and individual providers. In addition, a fourth survey, the Cardiovascular Risk Survey, targeted those at high risk for CVD events and a comparison group of well-controlled patients. These focused surveys are cross-sectional in design and focus on reasons for poor intermediate outcomes (i.e., poor levels of control of A1C, blood pressure, and LDL-C). Data were collected from 1,137 individuals during 2005-2006. Patient data were collected via computer assisted telephone interviews (CATI) and mailed questionnaires to optimize response rates. The 6 analyses proposed here are part of a legacy study that seeks to extend the scientific questions that can be asked from the data sets. At the Indiana University (IU) TRIAD site, we have elected to focus primarily on the Cardiovascular Risk Survey to address the following questions and illuminate the following issues: 1) What are the correlates of CVD risk factor control in adults with diabetes;2) What is the role that patient-perceived barriers to medication use play in CVD outcomes;3) What is the correlation between patients risk perception and control of cardiovascular risk factors;and 4) Understanding physicians'decisions to initiate or not initiate insulin in type 2 patients who are oral hyperglycemic failures. In addition, the IU TRIAD site will also evaluate two pilot interventions that were conducted with the IU TRIAD collaborating health plans;1) Evaluating the impact of a pilot intervention to improve medication adherence in diabetic adults with self-reported barriers to taking medications as prescribed by their providers, 2) Process and outcomes of efforts to implement clinic-community linkages to prevent Type 2 diabetes in 3 systems of health care.
/Relevance: The TRIAD Study conducted research to better understand how managed care organizations were implementing diabetes care procedures and how these strategies were affecting both short and longer term diabetes and CVD outcomes. The Indiana University Translational Research Center proposes six analyses that utilize the TRIAD data to address important questions that will better illuminate how diabetes care should be optimally organized in the future.