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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

Analysis at the patient level across all 3 interventions.
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Figure 5: Analysis at the patient level across all 3 interventions.

Mentions: Patients at two clinics received both the point-of-care PRC and were assigned to providers receiving the enhanced PrRC. These patients performed the same on glycemic and lipid measures but worse on blood pressure control than patients at the two clinics receiving neither of these interventions (data not shown). These intervention patients had an 0.5% absolute increase in blood pressure control (< 130/80 mm Hg) compared to a 3.8% absolute increase among control patients (GEE SE 0.009 p = 0.041, CI 0.002 - 0.073). In addition, analysis was performed at the patient level, comparing the eight different intervention arms, made up of the 2 × 2 PRC and PrRC design combined with patient PRC mailings. There was no difference in process or intermediate glycemic, lipid, and blood pressure outcomes performance between patients that received all 3 interventions (mailed PRC, point-of-care PRC, and providers with enhanced PrRC) and those who received either none, one, or two of the 3 possible interventions (See Figure 5 for display of glycemic analysis).


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)

Analysis at the patient level across all 3 interventions.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Analysis at the patient level across all 3 interventions.
Mentions: Patients at two clinics received both the point-of-care PRC and were assigned to providers receiving the enhanced PrRC. These patients performed the same on glycemic and lipid measures but worse on blood pressure control than patients at the two clinics receiving neither of these interventions (data not shown). These intervention patients had an 0.5% absolute increase in blood pressure control (< 130/80 mm Hg) compared to a 3.8% absolute increase among control patients (GEE SE 0.009 p = 0.041, CI 0.002 - 0.073). In addition, analysis was performed at the patient level, comparing the eight different intervention arms, made up of the 2 × 2 PRC and PrRC design combined with patient PRC mailings. There was no difference in process or intermediate glycemic, lipid, and blood pressure outcomes performance between patients that received all 3 interventions (mailed PRC, point-of-care PRC, and providers with enhanced PrRC) and those who received either none, one, or two of the 3 possible interventions (See Figure 5 for display of glycemic analysis).

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