Limits...
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.

Show MeSH

Related in: MedlinePlus

Consort flow diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3050679&req=5

Figure 2: Consort flow diagram.

Mentions: Our diabetes registry contains more than 7,000 patients over age 17 who have had i) at least one visit to a DH primary care clinic within 18 months and ii) an ICD-9 code of 250.xx, indicating diabetes, in one of those visits. To ensure a broad intervention reach, we minimized exclusion criteria to patients older than 75 years, those without a valid mailing address, and those whose primary language was neither English nor Spanish. A total of 5,457 patients were randomized to this study (Figure 2).


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)

Consort flow diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Consort flow diagram.
Mentions: Our diabetes registry contains more than 7,000 patients over age 17 who have had i) at least one visit to a DH primary care clinic within 18 months and ii) an ICD-9 code of 250.xx, indicating diabetes, in one of those visits. To ensure a broad intervention reach, we minimized exclusion criteria to patients older than 75 years, those without a valid mailing address, and those whose primary language was neither English nor Spanish. A total of 5,457 patients were randomized to this study (Figure 2).

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