Improving Diabetes Care Among Patients Overdue for Recommended Testing: A Randomized Controlled Trial of Automated Telephone Outreach

  1. Dennis Ross-Degnan, SCD1
  1. 1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts;
  2. 2Ann Arbor VA Medical Center and the Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan;
  3. 3Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts;
  4. 4Clinical Programs and Quality Measurement, Harvard Pilgrim Health Care, Wellesley, Massachusetts.
  1. Corresponding author: Steven R. Simon, steven_simon{at}


OBJECTIVE The study's objective was to assess the effects of automated telephone outreach with speech recognition (ATO-SR) on diabetes-related testing.

RESEARCH DESIGN AND METHODS We identified 1,200 health plan members who were overdue for diabetes-related testing and randomly allocated 600 to ATO-SR and 600 to usual care (no intervention). The intervention included three interactive calls encouraging recommended testing. The primary outcome was retinopathy testing, since this was the health plan's principal goal. Tests for glycemia, hyperlipidemia, and nephropathy were secondary outcomes.

RESULTS In total, 232 participants (39%) verbally responded to the calls. There was no difference between the intervention and the usual care groups in the primary outcome (adjusted hazard ratio 0.93 [95% CI 0.71–1.22]) and no effect of the intervention on any of the secondary outcomes.

CONCLUSIONS Fewer than 40% of the patients randomized to ATO-SR interacted verbally with the system. The intervention had no effect on the study's outcomes.


  • Clinical trial reg. no. NCT00790530,

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

  • Received December 21, 2009.
  • Accepted March 17, 2010.

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