title: The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial.
abstract: BACKGROUND
  Most studies of diabetes self-management that show improved clinical outcome performance involve multiple, time-intensive educational sessions in a group format. Most provider performance feedback interventions do not improve intermediate outcomes, yet lack targeted, patient-level feedback.
  
  
  METHODS
  5,457 low-income adults with diabetes at eight federally-qualified community health centers participated in this nested randomized trial. Half of the patients received report card mailings quarterly; patients at 4 of 8 clinics received report cards at every clinic visit; and providers at 4 of 8 clinics received quarterly performance feedback with targeted patient-level data. Expert-recommended glycemic, lipid, and blood pressure outcomes were assessed. Assessment of report card utility and patient and provider satisfaction was conducted through mailed patient surveys and mid- and post-intervention provider interviews.
  
  
  RESULTS
  Many providers and the majority of patients perceived the patient report card as being an effective tool. However, patient report card mailings did not improve process outcomes, nor did point-of-care distribution improve intermediate outcomes. Clinics with patient-level provider performance feedback achieved a greater absolute increase in the percentage of patients at target for glycemic control compared to control clinics (6.4% vs 3.8% respectively, Generalized estimating equations Standard Error 0.014, p < 0.001, CI -0.131 - -0.077). Provider reaction to performance feedback was mixed, with some citing frustration with the lack of both time and ancillary resources.
  
  
  CONCLUSIONS
  Patient performance report cards were generally well received by patients and providers, but were not associated with improved outcomes. Targeted, patient-level feedback to providers improved glycemic performance. Provider frustration highlights the need to supplement provider outreach efforts.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00827710.
authors.affiliation: Community Health Services, Denver Health and Hospital Authority, 80204, USA. henry.fischer@dhha.org
authors.forename: Henry H
authors.initials: HH
authors.lastname: Fischer
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Eisert
authors.forename: M Josh
authors.initials: MJ
authors.lastname: Durfee
authors.forename: Susan L
authors.initials: SL
authors.lastname: Moore
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Steele
authors.forename: Kevin
authors.initials: K
authors.lastname: McCullen
authors.forename: Katherine
authors.initials: K
authors.lastname: Anderson
authors.forename: Lara
authors.initials: L
authors.lastname: Penny
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Mackenzie
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000592:standards; D003695:Delivery of Health Care; D003920:Diabetes Mellitus / Q000451:nursing / Q000628:therapy*; D006801:Humans; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic; D019095:Point-of-Care Systems; D012042:Registries; D012648:Self Care; D017749:Total Quality Management