Abstract

Purpose: To assess whether providing customized clinical information to patients and physicians improves safety or quality of diabetes care.

Methods: Study subjects inlcuded123 primary care physicians and 3,703 eligible adult diabetes patients with elevated glycated hemoglobin (A1c) or LDL-cholesterol, who were randomized to receive customized feedback of clinical information as follows: (a) patient only, (b) physician only, (c) both the patient and physician, or (d) neither the patient nor physician. In the intervention groups, patients received customized mailed information, or physicians received printed, prioritized lists of patients with recommended clinical actions and performance feedback. Analysis employed hierarchical models to accommodate group randomization.

Results: Study interventions did not improve A1c test ordering (p=0.35) and negatively affected LDL test ordering (p<0.001) in the 12 months post-intervention. Interventions had no effect on LDL values (p=0.64), which improved in all groups over time. Interventions had a borderline unfavorable effect on A1c values among those with baseline A1c >=7% (p=0.10), and an unfavorable effect on A1c values among those with baseline A1c>= 8% (p<0.01). Interventions did not reduce risky prescribing events, or increase treatment intensification. Time to next visit was longer in all intervention groups compared to control (p<.05).

Conclusions: Providing customized decision support to physicians and/or patients did not improve quality or safety of diabetes care, and worsened A1c control in patients with baseline A1c >= 8%. Future interventions should consider providing point of care decision support with redesign of office systems, and/or incentives to increase appropriate actions in response to decision support information.