title: Improving diabetes outcomes using a web-based registry and interactive education: a multisite collaborative approach.
abstract: BACKGROUND
  To support the adoption of guideline concordant care by primary care practices, the New York Diabetes Coalition (NYDC) promoted use of an electronic diabetes registry and developed an interactive educational module on using the registry and improving patient communication. The NYDC hypothesized that use of a registry with immediate feedback would achieve measurable and clinically meaningful improvement in the proportion of patients at goal for diabetes health metrics.
  
  
  METHODS
  In 2006-2007, the NYDC recruited 7 small to midsized primary care practices to implement the registry and to receive education and coaching on registry use, practice work flow, and patient engagement. The patient cohort included those with 2 or more visits with a diagnosis of diabetes within a 12-month period. Each patient's health measure status (at goal, above goal, not recorded) was assessed quarterly for hemoglobin A1C , low-density lipoprotein (LDL), and blood pressure (BP), and most recent A1C value was noted. A cohort analysis was performed using random effects regression models to assess the impact of the registry over time for each diabetes health metric.
  
  
  RESULTS
  After controlling for variability between sites, with each subsequent quarter during the registry period patients were 1.4 times more likely to have A1C ≤ 9, almost twice (OR = 1.8) as likely to have LDL < 100, and 1.3 times more likely to have BP < 140/90. These improvements in compliance were statistically significant. Average A1C also improved over time, though this did not reach statistical significance.
  
  
  CONCLUSIONS
  Utilizing a Web-based registry and interactive education, the project demonstrated improved patient outcomes, as well as the feasibility of collecting aggregate data from unrelated, independent practices.
authors.affiliation: Center for Continuing Medical Education, Albert Einstein College of Medicine, Bronx, NY 10471, USA. rwmorrowmd@aol.com
authors.forename: Robert W
authors.initials: RW
authors.lastname: Morrow
authors.forename: Jason
authors.initials: J
authors.lastname: Fletcher
authors.forename: Kim F
authors.initials: KF
authors.lastname: Kelly
authors.forename: Laura A
authors.initials: LA
authors.lastname: Shea
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Spence
authors.forename: Janet N
authors.initials: JN
authors.lastname: Sullivan
authors.forename: Joan R
authors.initials: JR
authors.lastname: Cerniglia
authors.forename: Yoonjung
authors.initials: Y
authors.lastname: Yang
mesh_terms: D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D006265:Health Care Coalitions; D006801:Humans; D020407:Internet; D009519:New York City; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care / Q000379:methods; D019984:Quality Indicators, Health Care; D012042:Registries / Q000706:statistics & numerical data; D013997:Time Factors