A Controlled Trial of Web-Based Diabetes Disease Management

Abstract

OBJECTIVE -To test effects of a web-based decision support tool, the diabetes Disease Management Application (DMA), developed to improve evidence-based management of type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a group randomized controlled trial of 12 intervention and 14 control staff providers and 307 intervention and 291 control patients with type 2 diabetes in a hospital-based internal medicine clinic. Providers were randomly assigned from May 1998 through April 1999 to have access to the DMA (intervention) or not to have access (control). The DMA displays interactive patient-specific clinical data, treatment advice, and links to other web-based care resources. We compared patients in the intervention and control groups for changes in processes and outcomes of care from the year preceding the study through the year of the study by intention-to-treat analysis.RESULTS -The DMA was used for 42% of scheduled patient visits. The number of HbA 1c tests obtained per year increased significantly in the intervention group (ϩ0.3 tests/year) compared with the control group (Ϫ0.04 tests/year, P ϭ 0.008), as did the number of LDL cholesterol tests (intervention, ϩ0.2 tests/year; control, ϩ0.01 tests/year; P ϭ 0.02) and the proportions of patients undergoing at least one foot examination per year (intervention, ϩ9.8%; control, Ϫ0.7%; P ϭ 0.003). Levels of HbA 1c decreased by 0.2 in the intervention group and increased by 0.1 in the control group (P ϭ 0.09); proportions of patients with LDL cholesterol levels Ͻ130 mg/dl increased by 20.3% in the intervention group and 10.5% in the control group (P ϭ 0.5).CONCLUSIONS -Web-based patient-specific decision support has the potential to improve evidence-based parameters of diabetes care. Diabetes Care 26:750 -757, 2003D iabetes, primarily type 2 diabetes, affects Ͼ12% of the adult U.S. population and has become increasingly common over the past decade (1). Patients with type 2 diabetes are affected by microvascular complications, but cardiovascular disease (CVD) complications take the greatest toll (2). Diabetes and its complications cause substantial loss in quality of life, are the fourth most frequent reason for ambulatory physician visits, and incur Ͼ100 billion dollars in U.S. health care expenditures annually (3-5). There is probably no other common condition with a more pernicious effect than diabetes on patient health and health care budgets.Fortunately, there is now abundant evidence that complications of diabetes are preventable. Simple screening interventions can prevent visual loss and serious foot lesions (6,7), and intensive control of glycemia, blood pressure, and lipid levels slow the incidence and progression of microvascular and CVD complications (8). This evidence provides the basis for diabetes care guidelines promulgated by the American Diabetes Association (ADA) and other expert panels (9 -12). Regrettably, studies consistently document a large gap between evidencebased standards and current diabetes care in the U.S. For instance, only ϳ50% of ...

The Impact of ICT on Health Promotion: A Randomized Experiment with Diabetic Patients

“…Our results present a less optimistic picture of the potential benefits of web platforms for the empowerment of patients with chronic diseases than some of the previous literature (Harno et al, 2006;Meigs et al, 2003;and McKay et al, 2001).…”

“…They found significantly lower levels of HbA1c, blood pressure, cholesterol and fasting plasma glucose in the study group relative to the control individuals, and a lower number of visits by the study patients to doctors and nurses. Meigs et al (2003) tested the effects of the Disease Management Application (DMA), a web-based decision support tool for diabetics developed to improve evidence-based management of type 2 diabetes.…”

Clinical Inertia and Outpatient Medical Errors

“…There is substantial evidence to support this third point as well. [32][33][34][35][36][37][38] While the clinical points made by Phillips disease care. In chronic disease management, the task faced by health care providers (and the patient) is one in which decisions are made to control a process that is manifest in varying states of patient health.…”

“…Three recent randomized trials illustrate both the potential and the limitations of currently available decision support systems for chronic disease care. 35,36,60 In 2003, Meigs et al 36 reported that an electronic medical record (EMR) that prompted physicians to intensify therapy, but did not provide tailored or specific decision support (what drug, what dose), failed to improve A1c levels. In a 2002 Mayo Clinic study, a similar rudimentary decision support delivered through an EMR system increased frequency of A1c testing but failed to improve A1c levels.…”

Incorporating PDA Use in Diabetes Self-Care: A Central Texas Primary Care Research Network (CenTexNet) Study

“…Although some uncontrolled studies have reported benefits regarding metabolic control, 7,8 recent controlled studies have demonstrated little or no such benefits besides the EMRs helping to increase the number of tests ordered. 9,10 Other newer e-health strategies that have been evaluated in diabetes management include the Internet combined with short message service (SMS), 11 Web-based support systems, 12,13 electronic clinical reminders incorporated into diThis article was externally peer reviewed. Submitted 20 September 2006; revised 15 Decemberabetes self-care education programs, 14,15 and the PDA.…”