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

Abstract

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.

Impact of Information Technology–Based Interventions for Type 2 Diabetes Mellitus on Glycemic Control: A Systematic Review and Meta-Analysis

“…Among the studies, 2 randomized controlled trials did not show a significant improvement in the levels of HbA 1c [24,25]. However, the first of these evaluated the effects of a registry-generated audit for diabetes, as well as feedback and patient reminder interventions on diabetes care, for 483 diabetic patients [24].…”

More Extensive Implementation of the Chronic Care Model is Associated with Better Lipid Control in Diabetes

“…Other investigators have used these same outcome measures in cohort designs to study the effect of QI interventions and found no improvement in any of these 3 variables, 19 improvements in LDL and BP but not A1C, 20 or improvements in A1C and BP but not LDL. 21 Improving patient- or population-level clinical outcomes involves complex issues that rely on patient-, practice-, and system-level factors, and partial implementation of key drivers may have only small effects on outcome measures.…”

Republished original article: Resident-initiated interventions to improve inpatient heart-failure management

“…Similarly, an assessment of the validity of performance measures for coronary artery disease revealed that 15% to 81% of apparent quality failures in EHRs were actually audit failures,11 leading to questions about whether differences in performance reflect measurement or documentation errors as opposed to actual differences in quality of care 12. As residents wrestled with problems in clinical decision support13 14 and feedback systems,15–17 they discovered how to modify standardised codes,13 15 18 physician alerts and clinical reminders to aid in their own decision-making and improve their own quality of patient care.…”