In addition , the more CCM-incorporated the information technology-based interventions were , the more improvements there were in HbA1c levels .
CONCLUSIONS Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes .
No clinical ly relevant impact was observed on low-density lipoprotein levels and blood pressure , but there was evidence that the cost of care was lower
BACKGROUND Information technology-based interventions are increasingly being used to manage health care .
However , there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes .
OBJECTIVE The objective of this study was to conduct a systematic review and meta- analysis of clinical trials , assessing the impact of information technology on changes in the levels of hemoglobin A1c ( HbA1c ) and mapping the interventions with chronic care model ( CCM ) elements .
A pragmatic cluster randomised controlled trial of a Diabetes REcall And Management system: the DREAM trial
Abstract Background Following the introduction of a  computerised diabetes register in part of the northeast of Engl and , care initially improved but then plateaued . We therefore enhanced the existing diabetes register to address these problems . The aim of the trial was to evaluate the effectiveness and efficiency of an area wide ' extended , ' computerised diabetes register incorporating a full structured recall and management system , including individualised patient management prompts to primary care clinicians based on locally-adapted , evidence -based guidelines . Methods The study design was a pragmatic , cluster r and omised controlled trial , with the general practice as the unit of r and omisation . Set in 58 general practice s in three Primary Care Trusts in the northeast of Engl and , the study outcomes were the clinical process and outcome variables held on the diabetes register , patient-reported outcomes , and service and patient costs . The effect of the intervention was estimated using generalised linear models with an appropriate error structure . To allow for the clustering of patients within practice s , population averaged models were estimated using generalized estimating equations . Results Patients in intervention practice s were more likely to have at least one diabetes appointment recorded ( OR 2.00 , 95 % CI 1.02 , 3.91 ) , to have a recording of a foot check ( OR 1.87 , 95 % CI 1.09 , 3.21 ) , have a recording of receiving dietary advice ( OR 2.77 , 95 % CI 1.22 , 6.29 ) , and have a recording of blood pressure ( BP ) ( OR 2.14 , 95 % CI 1.06 , 4.36 ) . There was no difference in mean HbA1c or BP levels , but the mean cholesterol level in patients from intervention practice s was significantly lower ( -0.15 mmol/l , 95 % CI -0.25 , -0.06 ) . There were no differences in patient-reported outcomes or in patient-reported use of drugs , or uptake of health services . The average cost per patient was not significantly different between the intervention and control groups . Costs incurred in administering the system at the register and in general practice were in addition to these . Conclusion This study has shown benefits from an area-wide , computerised diabetes register incorporating a full structured recall and individualised patient management system . However , these benefits were achieved at a cost . In future , these costs may fall as electronic data exchange becomes a reliable reality . Trial registration : International St and ard R and omised Controlled Trial Number ( IS RCT N ) Register , IS RCT N32042030
In addition , the more CCM-incorporated the information technology-based interventions were , the more improvements there were in HbA1c levels .
CONCLUSIONS Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes .
No clinical ly relevant impact was observed on low-density lipoprotein levels and blood pressure , but there was evidence that the cost of care was lower
BACKGROUND Information technology-based interventions are increasingly being used to manage health care .
However , there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes .
OBJECTIVE The objective of this study was to conduct a systematic review and meta- analysis of clinical trials , assessing the impact of information technology on changes in the levels of hemoglobin A1c ( HbA1c ) and mapping the interventions with chronic care model ( CCM ) elements .