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

• Main Authors: Steele Andrew W, Moore Susan L, Durfee M Josh, Eisert Sheri L, Fischer Henry H, McCullen Kevin, Anderson Katherine, Penny Lara, Mackenzie Thomas D
• Format: Article
• Language: English
• Published: BMC 2011-02-01
• Series: BMC Medical Informatics and Decision Making
• Online Access: http://www.biomedcentral.com/1472-6947/11/12

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00827710">NCT00827710</a></p>