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

Study Overview
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Brief Summary
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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?

Detailed Description
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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.

Conditions
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Diabetes

Intervention / Treatment
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* Behavioral: point of care patient report cards
* Behavioral: Provider performance report card


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

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

| Outcome Measure | Measure Description | 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 | Measure Description | 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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diabetes, registry, computer, self management