Clinical Scorecard: Advancing Person-Centered Diabetes Care: Turning Patients’ Priorities Into Action

At a Glance

Key Highlights

• In the cluster randomized QBSafe trial, the intervention did not significantly improve illness and treatment intrusiveness, HbA1c, treatment burden, diabetes distress, or quality of life at 6 months.
• Intervention-group clinicians reported greater encounter satisfaction and confidence in addressing patients’ concerns.
• At 6 months, medication adherence was 77.2% in the intervention group versus 64.6% in controls; diabetes medication changes occurred in 33.8% versus 23.2%, respectively.
• Encounter duration did not increase, and cards were discussed during the first half of 88.9% of intervention visits.
• The article describes priority elicitation as a starting point: addressing identified needs may require longitudinal support and broader clinical and community resources.

Guideline-Based Recommendations

Diagnosis

Management

• Use structured agenda-setting to help patients identify concerns they most want addressed during a primary care visit.
• Integrate patients’ preferences and values into diabetes treatment discussions and decisions.
• Consider agenda-setting tools an entry point to responsive care, with follow-up support from a broader team when needed.

Monitoring & Follow-up

• The trial assessed illness and treatment intrusiveness, HbA1c, treatment burden, diabetes distress, quality of life, medication adherence, and medication changes.

Risks

• The intervention did not significantly improve the primary patient-reported outcome or HbA1c and did not improve treatment burden, diabetes distress, or quality of life at 6 months.
• Eliciting concerns may reveal needs that a clinician cannot address alone because of limited time, expertise, or resources.

Patient & Prescribing Data

The trial enrolled 143 adults with T2D and HbA1c above 8%. At baseline, mean HbA1c was 10%; 72.7% identified as Hispanic, 61.5% reported Spanish as their primary language, 91.3% had household incomes below 150% of the federal poverty level, and one-quarter lacked insurance.

Participants selected up to three of 14 cards covering living with diabetes, treatment burden, competing priorities, symptoms, and other challenges. At 6 months, medication adherence and medication changes were more frequent in the intervention group than in controls, while the measured primary and other patient-reported outcomes and HbA1c did not significantly improve.

Clinical Best Practices

• Invite patients to identify the concern they most urgently want help with before or at the start of the visit.
• Discuss selected priorities early in the encounter; in the trial, cards were discussed during the first half of 88.9% of intervention visits.
• Recognize that identifying a concern does not itself provide the resources needed to resolve it.
• Consider longitudinal support from pharmacists, diabetes educators, behavioral health clinicians, community health workers, or care coordinators, as proposed in the article.

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