Use of a registry-generated audit, feedback, and patient reminder intervention in an internal medicine resident clinic--a randomized trial.
BACKGROUND
Disease registries, audit and feedback, and clinical reminders have been reported to improve care processes.


OBJECTIVE
To assess the effects of a registry-generated audit, feedback, and patient reminder intervention on diabetes care.


METHODS
Randomized controlled trial conducted in a resident continuity clinic during the 2003-2004 academic year.


METHODS
Seventy-eight categorical Internal Medicine residents caring for 483 diabetic patients participated. Residents randomized to the intervention (n = 39) received instruction on diabetes registry use; quarterly performance audit, feedback, and written reports identifying patients needing care; and had letters sent quarterly to patients needing hemoglobin A1c or cholesterol testing. Residents randomized to the control group (n = 39) received usual clinic education.


METHODS
Hemoglobin A1c and lipid monitoring, and the achievement of intermediate clinical outcomes (hemoglobin A1c <7.0%, LDL cholesterol <100 mg/dL, and blood pressure <130/85 mmHg) were assessed.


RESULTS
Patients cared for by residents in the intervention group had higher adherence to guideline recommendations for hemoglobin A1c testing (61.5% vs 48.1%, p = .01) and LDL testing (75.8% vs 64.1%, p = .02). Intermediate clinical outcomes were not different between groups.


CONCLUSIONS
Use of a registry-generated audit, feedback, and patient reminder intervention in a resident continuity clinic modestly improved diabetes care processes, but did not influence intermediate clinical outcomes.
Thomas
Kris G
KG
Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA. thomas.kris@mayo.edu
Thomas
Matthew R
MR
Stroebel
Robert J
RJ
McDonald
Furman S
FS
Hanson
Gregory J
GJ
Naessens
James M
JM
Huschka
Todd R
TR
Kolars
Joseph C
JC
D003133:Commission on Professional and Hospital Activities; D003266:Continuity of Patient Care; D003920:Diabetes Mellitus / Q000628:therapy*; D005246:Feedback; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000592:standards*; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D015397:Program Evaluation; D012042:Registries; D017010:Reminder Systems