, Volume 22, Issue 12, pp 1740-1744
Date: 01 Nov 2007

Use of a Registry-generated Audit, Feedback, and Patient Reminder Intervention in an Internal Medicine Resident Clinic—A Randomized Trial

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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.

DESIGN

Randomized controlled trial conducted in a resident continuity clinic during the 2003–2004 academic year.

PARTICIPANTS

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.

MEASUREMENTS

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.