title: Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial.
abstract: BACKGROUND
  Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians.
  
  
  METHODS
  We randomized 11 primary care practices. Intervention practices received access to a DM-specific PHR that imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a "Diabetes Care Plan" for electronic submission to their physician prior to upcoming appointments. Active control practices received a PHR to update and submit family history and health maintenance information. All patients attending these practices were encouraged to sign up for online access.
  
  
  RESULTS
  We enrolled 244 patients with DM (37% of the eligible population with registered online access, 4% of the overall population of patients with DM). Study participants were younger (mean age, 56.1 years vs 60.3 years; P < .001) and lived in higher-income neighborhoods (median income, $53,784 vs $49,713; P < .001) but had similar baseline glycemic control compared with nonparticipants. More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; P < .001) compared with active controls. However, there were no significant differences in risk factor control between study arms after 1 year (P = .53).
  
  
  CONCLUSIONS
  Previsit use of online PHR linked to the EMR increased rates of DM-related medication adjustment. Low rates of online patient account registration and good baseline control among participants limited the intervention's impact on overall risk factor control.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00251875.
authors.affiliation: Division of General Medicine, Massachusetts General Hospital, 50-9 Staniford St, Boston, Massachusetts 02114, USA. Rgrant@partners.org
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Wald
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
authors.forename: Tejal K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: Eric G
authors.initials: EG
authors.lastname: Poon
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Williams
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Volk
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation / Q000379:methods*; D011320:Primary Health Care; D012307:Risk Factors
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