The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial.
BMC Med Inform Decis Mak
; 11: 12, 2011 Feb 17.
Article
in En
| MEDLINE
| ID: mdl-21329495
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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Registries
/
Diabetes Mellitus
Type of study:
Clinical_trials
Aspects:
Patient_preference
Limits:
Adult
/
Humans
Language:
En
Journal:
BMC Med Inform Decis Mak
Journal subject:
INFORMATICA MEDICA
Year:
2011
Document type:
Article
Affiliation country:
United States