Diabetes Clinical Trial
Can we improve diabetes outcomes through 1) report card mailings to patients 2) point of care distribution of report cards to patients and 3) provider performance feedback with patient level data?
Our federally qualified health care center serves over 7000 diabetic patients, many of whom
are uninsured (43%) or on medicaid (18%) or medicare (26%). The population is 54% Latino,
25% Caucasian, and 14% African American. We excluded patients older than 75; those without
English or Spanish as a first language; and the homeless. The remaining 5457 patients were
randomized to this one-year study which ended January 1, 2009. One-half of the enrolled
patients received quarterly mailed report cards on their HgA1c, blood pressure, and lipid
performance. They were asked to pick from a list of self-management goals and to see their
provider if their last visit was more than 2 months prior to the mailing. In a 2x2 design,
our eight clinics were randomized to i) on-site printing of patient report cards or no
on-site printing and ii) standard provider performance report cards or enhanced provider
report cards. The standard provider report cards included data on provider performance on
HgA1c, LDL, and blood pressure compared to other providers. The enhanced provider report
card also included a list of up to 10 patients not at HgA1c, LDL, or blood pressure goal.
The provider report cards were distributed on a quarterly basis, and the point of care
patient report cards were distributed at every clinic visit.
We are analyzing the impact of the intervention on the percent of patients at expert
recommended goals for glycemic, lipid, and blood pressure control. We are also performing a
qualitative analysis to describe provider and patient attitudes toward the interventions.
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Allocation: Randomized, Intervention Model: Factorial Assignment, Masking: Open Label, Primary Purpose: Health Services Research
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