A Randomized Trial of Three Diabetes Registry Implementation Strategies in a Community Internal Medicine Practice

Stroebel, Robert J.; Scheitel, Sidna M.; Fitz, John S.; Herman, Ruth A.; Naessens, James M.; Scott, Christopher G.; Zill, David A.; Müller, Lisa Marie

doi:10.1016/s1070-3241(02)28044-x

Cited by 36 publications

(32 citation statements)

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“…Disease registries improve process and outcome measures for chronic disease management but are used by less than half of all US physician organizations with more than 20 providers. [12][13][14] Disease registries commonly supplement the patient record, constituting a parallel documentation system; their shortcomings include duplicate data input and, often, a significant time lag before current patient data is recorded in the registry. 15,16 They typically address single conditions and omit preventive care needs.…”

Section: Introductionmentioning

confidence: 99%

Improving Population Care with an Integrated Electronic Panel Support Tool

Zhou

Unitan²,

Wang³

et al. 2011

Population Health Management

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This study measured the impact of an electronic Panel Support Tool (PST) on primary care teams' performance on preventive, monitoring, and therapeutic evidence-based recommendations. The PST, tightly integrated with a comprehensive electronic health record, is a dynamic report that identifies gaps in 32 evidence-based care recommendations for individual patients, groups of patients selected by a provider, or all patients on a primary care provider's panel. It combines point-of-care recommendations, disease registry capabilities, and continuous performance feedback for providers.A serial cross-sectional study of the PST's impact on care performance was conducted, retrospectively using monthly summary data for 207 teams caring for 263,509 adult members in Kaiser Permanente's Northwest region. Baseline care performance was assessed 3 months before first PST use and at 4-month intervals over 20 months of follow-up. The main outcome measure was a monthly care performance percentage for each provider, calculated as the number of selected care recommendations that were completed for all patients divided by the number of clinical indications for care recommendations among them. Statistical analysis was performed using the t test and multiple regression. Average baseline care performance on the 13 measures was 72.9% (95% confidence interval [CI], 71.8%-74.0%). During the first 12 months of tool use, performance improved to a statistically significant degree every 4 months. After 20 months of follow-up, it increased to an average of 80.0% (95% CI, 79.3%-80.7%).

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Section: Introductionmentioning

confidence: 99%

Improving Population Care with an Integrated Electronic Panel Support Tool

Zhou

Unitan²,

Wang³

et al. 2011

Population Health Management

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“…9 A study assessing diabetes registry implementation in our Internal Medicine (IM) faculty practice found improvements in process and intermediate clinical outcomes using registrygenerated audit and feedback combined with automated patient reminders. 10 Whether the benefits of such a system are transferable to a resident practice is unknown. We aimed to integrate registry-generated audit, feedback, and patient reminders into an IM resident continuity clinic and to assess the effects on diabetes care processes and intermediate clinical outcomes in this setting.…”

Section: Introductionmentioning

confidence: 99%

Use of a Registry-generated Audit, Feedback, and Patient Reminder Intervention in an Internal Medicine Resident Clinic—A Randomized Trial

Thomas

Stroebel

et al. 2007

J GEN INTERN MED

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BACKGROUND: Disease registries, audit and feedback, and clinical reminders have been reported to improve care processes. OBJECTIVE:To assess the effects of a registrygenerated audit, feedback, and patient reminder intervention on diabetes care. PARTICIPANTS: Seventy-eight categorical Internal Medicine residents caring for 483 diabetic patients participated. Residents randomized to the intervention (n=39) received instruction on diabetes registry use; quarterly performance audit, feedback, and written reports identifying patients needing care; and had letters sent quarterly to patients needing hemoglobin A1c or cholesterol testing. Residents randomized to the control group (n=39) received usual clinic education.MEASUREMENTS: Hemoglobin A1c and lipid monitoring, and the achievement of intermediate clinical outcomes (hemoglobin A1c <7.0%, LDL cholesterol <100 mg/dL, and blood pressure <130/85 mmHg) were assessed. RESULTS:Patients cared for by residents in the intervention group had higher adherence to guideline recommendations for hemoglobin A1c testing (61.5% vs 48.1%, p = .01) and LDL testing (75.8% vs 64.1%, p=.02). Intermediate clinical outcomes were not different between groups.CONCLUSIONS: Use of a registry-generated audit, feedback, and patient reminder intervention in a resident continuity clinic modestly improved diabetes care processes, but did not influence intermediate clinical outcomes.

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“…Among large medical groups, fewer than half have implemented improvement tools such as diabetes registries, tracking systems, case managers, feedback to physicians, or clinical guidelines with reminders, whereas other systems lack the technology necessary to sustain quality improvement eff o r t s ( 5 , 1 0 -1 2 ) . M a n y d i a b e t e s intervention studies are limited by inadequate sample size, nonrandomized patients and clinics, lack of control subjects, or limited scope of implementation within a single medical group or health system (11,13,14). Although some trials of quality improvement strategies have demonstrated small improvements in the process of care delivery, demonstrating improvement in control of A1C, LDL, and systolic blood pressure (SBP) has been more challenging (15)(16)(17)(18).…”

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confidence: 99%

Improving Diabetes Care in Practice

et al. 2008

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OBJECTIVE -The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practices.RESEARCH DESIGN AND METHODS -This was a group-randomized, controlled clinical trial evaluating the practical effectiveness of a multicomponent intervention (TRANSLATE) in 24 practices. The intervention included implementation of an electronic diabetes registry, visit reminders, and patient-specific physician alerts. A site coordinator facilitated previsit planning and a monthly review of performance with a local physician champion. The principle outcomes were the percentage of patients achieving target values for the composite of systolic blood pressure (SBP) Ͻ130 mmHg, LDL cholesterol Ͻ100 mg/dl, and A1C Ͻ7.0% at baseline and 12 months. Six process measures were also followed.RESULTS -Over 24 months, 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practices from 17 health systems. Diabetes process measures increased significantly more in intervention than in control practices, giving net increases as follows: foot examinations 35.0% (P Ͻ 0.0.001); annual eye examinations 25.9% (P Ͻ 0.001); renal testing 28.5% (P Ͻ 0.001); A1C testing 8.1%(P Ͻ 0.001); blood pressure monitoring 3.5% (P ϭ 0.05); and LDL testing 8.6% (P Ͻ 0.001). Mean A1C adjusted for age, sex, and comorbidity decreased significantly in intervention practices (P Ͻ 0.02). At 12 months, intervention practices had significantly greater improvement in achieving recommended clinical values for SBP, A1C, and LDL than control clinics (P ϭ 0.002).CONCLUSIONS -Introduction of a multicomponent organizational intervention in the primary care setting significantly increases the percentage of type 2 diabetic patients achieving recommended clinical outcomes.

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A Randomized Trial of Three Diabetes Registry Implementation Strategies in a Community Internal Medicine Practice

Cited by 36 publications

References 4 publications

Improving Population Care with an Integrated Electronic Panel Support Tool

Improving Population Care with an Integrated Electronic Panel Support Tool

Use of a Registry-generated Audit, Feedback, and Patient Reminder Intervention in an Internal Medicine Resident Clinic—A Randomized Trial

Improving Diabetes Care in Practice

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