A number of approaches have been tried to increase the frequency at which patients meet the ADA process and outcome recommendations. These have in- cluded simply reminding patients to keep their doctors’ appointments (48), having nurse educators call patients on a regular basis (49), providing specific information concerning the standards of care to both patients and physicians, alerting physicians at the time of the patients’ vis- its that specific standards have not been met (54,55), and intensive education of physicians (56 –58). All have been relatively ineffective.