Simulated provider training improves diabetes management
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Objective: Describe and evaluate software technology for innovative cognitive-based provider simulation training.
Method: SimCare Diabetes, the culmination of 3 federally-funded RCTs, uses simulated learning cases that replicate real and challenging clinical vignettes. The provider engages in patient care using a web-based interactive electronic health record-like interface over longitudinal patient encounters. The software captures effects of treatment actions using physiologic modeling, and uses evidence-based rules algorithms to critique them. The first two RCT's tested the intervention on practicing providers within HPMG. The last RCT evaluated an 18-case comprehensive learning curriculum as an adjunct to traditional training in primary care residents (n=341). Outcomes in these trials included A1c of actual patients, provider management skills (simulated assessments of appropriate and safe treatment decisions), knowledge testing (multiple choice test), self-reported confidence (Likert-scale), and satisfaction.
Result: The first two RCT interventions (a 1-3 hour time commitment of practicing providers) demonstrated a mean A1c reduction of .19% in actual patients (p=.04) and a 10% reduction in metformin prescriptions for patients with contraindications (p=.03). In the third trial, on average, 32% of intervention and 9% of control residents achieved composite clinical goals for glucose, blood pressure, and lipids on 4 simulated assessment cases. 71% of intervention residents (compared to 34% control) answered more than half the knowledge questions correctly, and overall diabetes management confidence was above average for 79.4% intervention and 43.9% of control, p<.001. Satisfaction was high; 88% of practicing providers and 91% of resident physicians would recommend to colleagues.
Conclusion: Evidence supports the use of case-based simulated diabetes education to improve patient outcomes and diabetes management of primary care physicians.