Meigs JB et al. 2003 "A controlled trial of web-based diabetes disease management - the MGH diabetes primary care improvement project."
Reference
Meigs JB, Cagliero E, Dubey A, et al. A controlled trial of web-based diabetes disease management - The MGH diabetes primary care improvement project. Diabetes Care 2003;26(3):750-757.
Abstract
"OBJECTIVE- To test effects of a web-based decision support tool...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 [decision support system] (intervention) or not to have access (control). The [decision support system] 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 [system] was used for 42% of scheduled patient visits. The number of HbA1c tests obtained per year increased significantly in the intervention group (+0.3 tests/year) compared with the control group (-0.04 tests/year, P = 0.008), as did the number of LDL cholesterol tests (intervention, +0.2 tests/year; control, +0.01 tests/year; P = 0.02) and the proportions of patients undergoing at least one foot examination per year (intervention, +9.8%; control, -0.7%; P = 0.003). Levels of HbA1c decreased by 0.2 in the intervention group and increased by 0.1 in the control group (P = 0.09); proportions of patients with LDL cholesterol levels<130 mg/dl increased by 20.3% in the intervention group and 10.5% in the control group (P = 0.5).
CONCLUSIONS- Web-based patient-specific decision support has the potential to improve evidence-based parameters of diabetes care."
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 [decision support system] (intervention) or not to have access (control). The [decision support system] 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 [system] was used for 42% of scheduled patient visits. The number of HbA1c tests obtained per year increased significantly in the intervention group (+0.3 tests/year) compared with the control group (-0.04 tests/year, P = 0.008), as did the number of LDL cholesterol tests (intervention, +0.2 tests/year; control, +0.01 tests/year; P = 0.02) and the proportions of patients undergoing at least one foot examination per year (intervention, +9.8%; control, -0.7%; P = 0.003). Levels of HbA1c decreased by 0.2 in the intervention group and increased by 0.1 in the control group (P = 0.09); proportions of patients with LDL cholesterol levels<130 mg/dl increased by 20.3% in the intervention group and 10.5% in the control group (P = 0.5).
CONCLUSIONS- Web-based patient-specific decision support has the potential to improve evidence-based parameters of diabetes care."
Objective
"To test effects of a web-based decision support tool...developed to improve evidence-based management of type 2 diabetes."
Type Clinic
Primary care
Type Specific
Internal medicine
Size
Large
Geography
Urban
Other Information
The study site was the Adult Medicine Clinic in Boston, Massachusetts; a hospital-based clinic staffed by residents.
Type of Health IT
Decision support system
Type of Health IT Functions
"The [decision support system] provides a single-screen view of patient-specific information, enabling decision support at the time of patient contact. It displays trended and tabular real-time electronic laboratory data interactively linked to evidence-based treatment recommendations, facilities to aid encounter workflow, and links to additional patient and provider care resources. Treatment recommendations were based on our synthesis of published efficacy data and national guidelines current at the time of the study...The [DSS] is not an involuntary reminder or prompting system: it must be actively opened, just as any on-line reference or EMR application. During the intervention year, the [DSS] was available to intervention providers to use if they wished."
Context or other IT in place
The electronic medical record (EMR) was Web-based. The clinic also used paper records.
Workflow-Related Findings
"On average, providers viewed the [DSS] for 42% of scheduled patient visits. Four of 12 providers (33%) viewed the [DSS] for >70% of patient visits, 33% of providers used the [DSS] for 28-30% of patient visits, and 33% of providers used the [DSS] for 0-17% of patient visits. Nurses and nurse practitioners used the [DSS] for 0-13% of patient visits."
"Rates of several process measures were improved with access to the [DSS]: the number of HbA1c and LDL cholesterol tests obtained and proportions of patients with at least one foot examination per year increased modestly but significantly in the intervention group compared with the control group."
Study Design
Randomized controlled trial (RCT)
Study Participants
The study participants included 12 intervention and 14 control staff providers, and 307 intervention and 291 control patients with type 2 diabetes.