A Controlled Trial of Web-Based Diabetes Disease Management
The MGH Diabetes Primary Care Improvement Project
- James B. Meigs, MD, MPH12,
- Enrico Cagliero, MD3,
- Anil Dubey, MD4,
- Patricia Murphy-Sheehy, MPH1,
- Catharyn Gildesgame, MBA2,
- Henry Chueh, MD24,
- Michael J. Barry, MD1,
- Daniel E. Singer, MD12 and
- David M. Nathan, MD3
- 1General Medicine Division, Department of Medicine, Harvard Medical School, Boston, Massachusetts
- 2Clinical Research Program, Harvard Medical School, Boston, Massachusetts
- 3Diabetes Unit, Department of Medicine, Harvard Medical School, Boston, Massachusetts
- 4Laboratory of Computer Science, Department of Medicine, Harvard Medical School, Boston, Massachusetts
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 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.
- ADA, American Diabetes Association
- AMC, Adult Medicine Clinic
- CVD, cardiovascular disease
- DMA, Disease Management Application
- EMR, electronic medical record
- HMO, health maintenance organization
- ICC, intracorrelation coefficient
Address correspondence and reprint requests to James B. Meigs, MD, MPH, General Medicine Division, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA 02114. E-mail:.
Received for publication 13 May 2002 and accepted in revised form 16 October 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
See accompanying editorial, p. 942.
- DIABETES CARE