Automated Diabetes Registry Tools to Enhance Patient Self-Management and Provider Performance Feedback

Can we improve diabetes outcomes through 1) report card mailings to patients 2) point of care distribution of report cards to patients and 3) provider performance feedback with patient level data?

Study Overview

• Status: Completed
• Conditions: Diabetes
• Intervention / Treatment: Behavioral: point of care patient report cards; Behavioral: Provider performance report card

Detailed Description

Our federally qualified health care center serves over 7000 diabetic patients, many of whom are uninsured (43%) or on medicaid (18%) or medicare (26%). The population is 54% Latino, 25% Caucasian, and 14% African American. We excluded patients older than 75; those without English or Spanish as a first language; and the homeless. The remaining 5457 patients were randomized to this one-year study which ended January 1, 2009. One-half of the enrolled patients received quarterly mailed report cards on their HgA1c, blood pressure, and lipid performance. They were asked to pick from a list of self-management goals and to see their provider if their last visit was more than 2 months prior to the mailing. In a 2x2 design, our eight clinics were randomized to i) on-site printing of patient report cards or no on-site printing and ii) standard provider performance report cards or enhanced provider report cards. The standard provider report cards included data on provider performance on HgA1c, LDL, and blood pressure compared to other providers. The enhanced provider report card also included a list of up to 10 patients not at HgA1c, LDL, or blood pressure goal. The provider report cards were distributed on a quarterly basis, and the point of care patient report cards were distributed at every clinic visit.

We are analyzing the impact of the intervention on the percent of patients at expert recommended goals for glycemic, lipid, and blood pressure control. We are also performing a qualitative analysis to describe provider and patient attitudes toward the interventions.

• Study Type: Interventional
• Enrollment (Actual): 5457
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Denver, Colorado, United States, 80204
      • Denver Health Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• icd9 code for diabetes
• primary care visit in the past 18 months
• English or Spanish as primary language

Exclusion Criteria:

• age more than 75
• No working address

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: 1; patients who received point-of-care report cards and were listed on provider performance report card	Behavioral: point of care patient report cards; gives patient feedback on performance on glycemic, lipid, and blood pressure control relative to expert recommended goals; Behavioral: Provider performance report card; Gives provider feedback on performance on their diabetes panel of patients and includes patient level data
Active Comparator: 2; Patients who received point-of-care diabetes report cards but were not listed on provider performance report card	Behavioral: point of care patient report cards; gives patient feedback on performance on glycemic, lipid, and blood pressure control relative to expert recommended goals
Active Comparator: 3; Patients who did not receive point-of-care report card but who were listed on provider performance report card	Behavioral: Provider performance report card; Gives provider feedback on performance on their diabetes panel of patients and includes patient level data
No Intervention: 4; Patients who did not receive point of care report card and who did were not listed on provider performance report card

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Percent of patients with HgA1c < 7	january 2009
Percent of patients with LDL < 100 mg/dL	january 2009
Percent of patients with BP < 130/80	january 2009

Secondary Outcome Measures

Outcome Measure	Time Frame
Percent of patients with A1c checked in last 6 months	january 2009
Percent of patients with LDL checked in past year	january 2009
Percent of patients with BP checked in past year	january 2009

Collaborators and Investigators

• Sponsor: Denver Health and Hospital Authority
• Collaborators: Agency for Healthcare Research and Quality (AHRQ)
• Investigators: Principal Investigator: henry h fischer, md, Denver Health and Hospital Authority

Publications and helpful links

General Publications

• Fischer HH, Eisert SL, Durfee MJ, Moore SL, Steele AW, McCullen K, Anderson K, Penny L, Mackenzie TD. The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial. BMC Med Inform Decis Mak. 2011 Feb 17;11:12. doi: 10.1186/1472-6947-11-12.

Study record dates

Study Major Dates

• Study Start: December 1, 2007
• Primary Completion (Actual): January 1, 2009
• Study Completion (Actual): May 1, 2009

Study Registration Dates

• First Submitted: January 14, 2009
• First Submitted That Met QC Criteria: January 21, 2009
• First Posted (Estimate): January 23, 2009

Study Record Updates

• Last Update Posted (Estimate): May 1, 2012
• Last Update Submitted That Met QC Criteria: April 29, 2012
• Last Verified: April 1, 2012

More Information

Terms related to this study

• Keywords: diabetes; self management; computer; registry
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus
• Other Study ID Numbers: AHRQ 290-2006-000-20; AHRQ Contract 290-2006-000-20