A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project.
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.


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 HbA(1c) 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 HbA(1c) 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.
Meigs
James B
JB
Department of Medicine, Harvard Medical School, Boston, Massachusetts 02114, USA. jmeigs@partners.org
Cagliero
Enrico
E
Dubey
Anil
A
Murphy-Sheehy
Patricia
P
Gildesgame
Catharyn
C
Chueh
Henry
H
Barry
Michael J
MJ
Singer
Daniel E
DE
Nathan
David M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior