title: A web-based diabetes intervention for physician: a cluster-randomized effectiveness trial.
abstract: OBJECTIVE
  To determine the effectiveness of a provider-based education and implementation intervention for improving diabetes control.
  
  
  METHODS
  Cluster-randomized trial with baseline and follow-up cross sections of diabetes patients in each participating physician's practice.
  
  
  METHODS
  Eleven US Southeastern states, 2006-08.
  
  
  METHODS
  Two hundred and five rural primary care physicians.
  
  
  METHODS
  Multi-component interactive intervention including Web-based continuing medical education, performance feedback and quality improvement tools. Primary Outcome Measures 'Acceptable control' [hemoglobin A1c ≤9%, blood pressure (BP) <140/90 mmHg, low-density lipoprotein cholesterol (LDL) <130 mg/dl] and 'optimal control' (A1c <7%, BP <130/80 mmHg, LDL <100 mg/dl).
  
  
  RESULTS
  Of 364 physicians attempting to register, 205 were randomized to the intervention (n= 102) or control arms (n= 103). Baseline and follow-up data were provided by 95 physicians (2127 patients). The proportion of patients with A1c ≤9% was similar at baseline and follow-up in both the control [adjusted odds ratio (AOR): 0.94; 95% confidence interval (CI): 0.61, 1.47] and intervention arms [AOR: 1.16 (95% CI: 0.80, 1.69)]; BP <140/90 mmHg and LDL <130 mg/dl were also similar at both measurement points (P= 0.66, P= 0.46; respectively). We observed no significant effect on diabetes control attributable to the intervention for any of the primary outcome measures. Intervention physicians engaged with the Website over a median of 64.7 weeks [interquartile range (IQR): 45.4-81.8) for a median total of 37 min (IQR: 16-66).
  
  
  CONCLUSIONS
  A wide-reach, low-intensity, Web-based interactive multi-component intervention did not improve control of glucose, BP or lipids for patients with diabetes of physicians practicing in the rural Southeastern US.
authors.affiliation: Veterans Affairs National Quality Scholars Program, Birmingham, AL, USA. cestrada@uab.edu
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Estrada
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Salanitro
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
authors.forename: William
authors.initials: W
authors.lastname: Curry
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Williams
authors.forename: Fernando
authors.initials: F
authors.lastname: Ovalle
authors.forename: Yongin
authors.initials: Y
authors.lastname: Kim
authors.forename: Pamela
authors.initials: P
authors.lastname: Foster
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D003920:Diabetes Mellitus / Q000628:therapy*; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D058007:Physicians, Primary Care / Q000193:education*; D011787:Quality of Health Care; D019035:Rural Health Services; D015144:Southeastern United States; D057170:Translational Research, Biomedical; D014584:User-Computer Interface