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Translating Research Into Action for Diabetes (TRIAD) Fact Sheet, 2009—Figure Text

Figure 1 TRIAD translational research centers and sponsor agencies

PHRI: Pacific Health Research Institute
KPNC: Kaiser Permanente Northern California
UCLA: University of California, Los Angeles
IU: Indiana University
U-M: University of Michigan
UMDNJ: University of Medicine and Dentistry of New Jersey
NIDDK: National Institute of Diabetes and Digestive and Kidney Diseases
CDC: Centers for Disease Control and Prevention

Figure 2 TRIAD conceptual model of relationships among system-level factors, processes, and outcomes of care

System factorsProcesses of careHealth outcomes
  • Health system structure
  • Disease management strategies
    • Performance feedback
    • Physician reminders
    • Guideline use
    • Formal case management
    • Patient education resources
  • Management of referral care
  • Clinician payment, incentives
  • Cost-containment strategies
  • Data systems
  • Periodic HbA1c testing
  • Periodic lipid testing
  • Retinal examinations
  • Periodic microalbuminuria testing
  • Periodic foot examinations
  • Smoking cessation counseling
  • Aspirin prescription/advise
  • Glycemic control
  • Blood pressure control
  • LDL-cholesterol control
  • Cardiovascular disease
  • Nephropathy/end stage renal disease
  • Retinopathy
  • Mortality
  • Health status
  • Symptoms
  • Utilization and costs

Figure 3 TRIAD conceptual model of relationships among patient factors, patient-system interactions, processes, and outcomes of care.

The components of this model, which is a flowchart, are:
Fixed patient factors: Demographics, socioeconomics, environment, disease severity, comorbidities
Patient-physician system interactions: Communication, trust, access to care, out-of-pocket costs
Care processes: HbA1c, blood pressure, LDL-cholesterol testing, nephropathy screening, dilated eye exam, foot exam, aspirin, smoking cessation advice
Behavior: Self-management, adherence, physical activity, diet, smoking
Outcomes: HbA1c, systolic blood pressure, LDL-cholesterol
Psychosocial factors: Depression, hopelessness, self-efficacy, social support
The flowchart begins with fixed patient factors, and ends with outcomes and care processes.
Fixed patient factors influence outcomes directly and by influencing other components, which are psychosocial factors, patient-physician system interactions, and behavior.
Patient-physician interactions influence care processes, behavior and fixed patient factors.
Psychosocial factors influence behavior and fixed patient factors.
Behavior influences outcomes.

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