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The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial.

Fischer HH, Eisert SL, Durfee MJ, Moore SL, Steele AW, McCullen K, Anderson K, Penny L, Mackenzie TD - BMC Med Inform Decis Mak (2011)

Bottom Line: 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).Targeted, patient-level feedback to providers improved glycemic performance.Provider frustration highlights the need to supplement provider outreach efforts.

View Article: PubMed Central - HTML - PubMed

Affiliation: Community Health Services, Denver Health and Hospital Authority, 80204, USA. henry.fischer@dhha.org

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.

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Related in: MedlinePlus

Venn diagram of patient assignments to each of the 3 interventions.
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Figure 1: Venn diagram of patient assignments to each of the 3 interventions.

Mentions: The intervention took place over 13 months at eight federally qualified community healthcare centers within Denver Health (DH), an urban safety-net healthcare system, ending January 1, 2009. A prospective randomized controlled design was used. Randomization for the mailed PRC took place at the patient level across the entire diabetes registry. Randomization took place at the clinic level in a 2 × 2 factorial design for the point-of-care PRC and the PrRC arms, stratified by clinic size. A given clinic was randomized to i) automated distribution of the point-of-care PRC or no distribution of the point-of-care PRC and ii) distribution of either a standard PrRC or an enhanced PrRC, which also included targeted patient level data. Of our eight clinics, 4 are relatively small and 4 are relatively large in size. We randomly assigned 1 large and 1 small clinic to each of the four design arms. Thus, a patient was randomized to one of eight possible intervention arms (Figure 1). The Colorado Multiple Institutional Review Board (COMIRB) approved this study prior to implementation. Review of our protocol by COMIRB concluded that a waiver of individual informed consent was appropriate due to the intervention being both of low risk to the patients and in accordance with quality improvement practices. In addition, the instructions provided with the self-administered survey included a clear statement that patient participation was at the patient's own discretion and was not in any way required.


The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial.

Fischer HH, Eisert SL, Durfee MJ, Moore SL, Steele AW, McCullen K, Anderson K, Penny L, Mackenzie TD - BMC Med Inform Decis Mak (2011)

Venn diagram of patient assignments to each of the 3 interventions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3050679&req=5

Figure 1: Venn diagram of patient assignments to each of the 3 interventions.
Mentions: The intervention took place over 13 months at eight federally qualified community healthcare centers within Denver Health (DH), an urban safety-net healthcare system, ending January 1, 2009. A prospective randomized controlled design was used. Randomization for the mailed PRC took place at the patient level across the entire diabetes registry. Randomization took place at the clinic level in a 2 × 2 factorial design for the point-of-care PRC and the PrRC arms, stratified by clinic size. A given clinic was randomized to i) automated distribution of the point-of-care PRC or no distribution of the point-of-care PRC and ii) distribution of either a standard PrRC or an enhanced PrRC, which also included targeted patient level data. Of our eight clinics, 4 are relatively small and 4 are relatively large in size. We randomly assigned 1 large and 1 small clinic to each of the four design arms. Thus, a patient was randomized to one of eight possible intervention arms (Figure 1). The Colorado Multiple Institutional Review Board (COMIRB) approved this study prior to implementation. Review of our protocol by COMIRB concluded that a waiver of individual informed consent was appropriate due to the intervention being both of low risk to the patients and in accordance with quality improvement practices. In addition, the instructions provided with the self-administered survey included a clear statement that patient participation was at the patient's own discretion and was not in any way required.

Bottom Line: 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).Targeted, patient-level feedback to providers improved glycemic performance.Provider frustration highlights the need to supplement provider outreach efforts.

View Article: PubMed Central - HTML - PubMed

Affiliation: Community Health Services, Denver Health and Hospital Authority, 80204, USA. henry.fischer@dhha.org

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.

Show MeSH
Related in: MedlinePlus