Clinical trial NCT00827710: Automated Diabetes Registry Tools to Enhance Patient Self-Management and Provider Performance Feedback
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diabetes
Keywords: diabetes
registry
computer
self management
Lead sponsor: Denver Health and Hospital Authority
Sponsor class: OTHER
Collaborators: name: Agency for Healthcare Research and Quality (AHRQ)
First posted: 2009-01-23
Enrollment: 5457
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Percent of patients with HgA1c < 7
timeFrame: january 2009
measure: Percent of patients with LDL < 100 mg/dL
timeFrame: january 2009
measure: Percent of patients with BP < 130/80
timeFrame: january 2009
Secondary outcomes:
measure: Percent of patients with A1c checked in last 6 months
timeFrame: january 2009
measure: Percent of patients with LDL checked in past year
timeFrame: january 2009
measure: Percent of patients with BP checked in past year
timeFrame: january 2009
Other outcomes:
Locations:
city: Denver
country: United States
facility: Denver Health Medical Center
state: Colorado
Study officials:
affiliation: Denver Health and Hospital Authority
name: henry h fischer, md
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.