The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial

Henry H Fischer, Sheri L Eisert, M Josh Durfee, Susan L Moore, Andrew W Steele, Kevin McCullen, Katherine Anderson, Lara Penny, Thomas D Mackenzie, Henry H Fischer, Sheri L Eisert, M Josh Durfee, Susan L Moore, Andrew W Steele, Kevin McCullen, Katherine Anderson, Lara Penny, Thomas D Mackenzie

Abstract

Background: Most studies of diabetes self-management that show improved clinical outcome performance involve multiple, time-intensive educational sessions in a group format. Most provider performance feedback interventions do not improve intermediate outcomes, yet lack targeted, patient-level feedback.

Methods: 5,457 low-income adults with diabetes at eight federally-qualified community health centers participated in this nested randomized trial. Half of the patients received report card mailings quarterly; patients at 4 of 8 clinics received report cards at every clinic visit; and providers at 4 of 8 clinics received quarterly performance feedback with targeted patient-level data. Expert-recommended glycemic, lipid, and blood pressure outcomes were assessed. Assessment of report card utility and patient and provider satisfaction was conducted through mailed patient surveys and mid- and post-intervention provider interviews.

Results: Many providers and the majority of patients perceived the patient report card as being an effective tool. However, patient report card mailings did not improve process outcomes, nor did point-of-care distribution improve intermediate outcomes. Clinics with patient-level provider performance feedback achieved a greater absolute increase in the percentage of patients at target for glycemic control compared to control clinics (6.4% vs 3.8% respectively, Generalized estimating equations Standard Error 0.014, p < 0.001, CI -0.131 - -0.077). Provider reaction to performance feedback was mixed, with some citing frustration with the lack of both time and ancillary resources.

Conclusions: Patient performance report cards were generally well received by patients and providers, but were not associated with improved outcomes. Targeted, patient-level feedback to providers improved glycemic performance. Provider frustration highlights the need to supplement provider outreach efforts.

Trial registration: ClinicalTrials.gov: NCT00827710.

Figures

Figure 1
Figure 1
Venn diagram of patient assignments to each of the 3 interventions.
Figure 2
Figure 2
Consort flow diagram.
Figure 3
Figure 3
Outcomes at clinics for point of care patient and provider reports.
Figure 4
Figure 4
Patient level analysis for enhanced versus standard provider report card sites.
Figure 5
Figure 5
Analysis at the patient level across all 3 interventions.

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