title: Use of a registry-generated audit, feedback, and patient reminder intervention in an internal medicine resident clinic--a randomized trial.
abstract: 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.
authors.affiliation: Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA. thomas.kris@mayo.edu
authors.forename: Kris G
authors.initials: KG
authors.lastname: Thomas
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Thomas
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stroebel
authors.forename: Furman S
authors.initials: FS
authors.lastname: McDonald
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Hanson
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.forename: Todd R
authors.initials: TR
authors.lastname: Huschka
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Kolars
mesh_terms: 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