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

Denver Health and Hospital Authority

Status: Completed

Conditions: Diabetes

Treatments: Behavioral: point of care patient report cards; Behavioral: Provider performance report card

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT00827710

AHRQ Contract 290-2006-000-20

AHRQ 290-2006-000-20

Details and patient eligibility

About

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?

Full 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.

Enrollment: 5,457 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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5,457 participants in 4 patient groups

1

Active Comparator group

Description:

patients who received point-of-care report cards and were listed on provider performance report card

Treatment:

Behavioral: Provider performance report card

Behavioral: point of care patient report cards

2

Active Comparator group

Description:

Patients who received point-of-care diabetes report cards but were not listed on provider performance report card

Treatment:

Behavioral: point of care patient report cards

3

Active Comparator group

Description:

Patients who did not receive point-of-care report card but who were listed on provider performance report card

Treatment:

Behavioral: Provider performance report card

4

No Intervention group

Description:

Patients who did not receive point of care report card and who did were not listed on provider performance report card