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The Translating Research Into Action for Diabetes (TRIAD) study: a multicenter study of diabetes in managed care.

D iabetes presents formidable challenges to the U.S. health care system because of its high prevalence and morbidity and the complexity and cost of managing the disease (1–2). Diabetes complications can be reduced with efficacious treatments, such as glycemic, blood pressure, lipid control and screening, and early treatment for eye, kidney, and foot disease (3–6); however, these treatments are not adequately implemented (7–11). Thus, there is a need to better understand modifiable factors that affect the quality and outcomes of care across diverse health care systems. The Translating Research Into Action for Diabetes (TRIAD) study uses Donabedian’s classic paradigm for studying quality of care by relating structural factors in health care systems and provider organization to the processes and outcomes of care (12). Because of the proliferation of managed care systems, with various organizational, reimbursement, and disease management approaches (13–20), managed care is a critical setting in which to apply this paradigm. The TRIAD study is a multicenter prospective study that seeks to identify modifiable barriers to optimal diabetes care across diverse managed care settings. This report describes TRIAD’s study hypotheses, objectives, design, participants, and methods.