Original Article

Journal of General Internal Medicine

, 24:1303

First online:

The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

  • Charles D. MacLeanAffiliated withDivision of General Internal Medicine, University of Vermont College of Medicine Email author 
  • , Michael GagnonAffiliated withDepartment of Information Services, Fletcher Allen Health Care
  • , Peter CallasAffiliated withDepartment of Biometry, University of Vermont
  • , Benjamin LittenbergAffiliated withDivision of General Internal Medicine, University of Vermont College of MedicineDepartment of Nursing, University of Vermont

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Optimal care for patients with diabetes is difficult to achieve in clinical practice.


To evaluate the impact of a registry and decision support system on processes of care, and physiologic control.


Randomized trial with clustering at the practice level, involving 7,412 adults with diabetes in 64 primary care practices in the Northeast.


Provider decision support (reminders for overdue diabetes tests, alerts regarding abnormal results, and quarterly population reports with peer comparisons) and patient decision support (reminders and alerts).


Process and physiologic outcomes were evaluated in all subjects. Functional status was evaluated in a random patient sample via questionnaire. We used multiple logistic regression to quantify the effect, adjusting for clustering and potential confounders. Intervention subjects were significantly more likely to receive guideline-appropriate testing for cholesterol (OR = 1.39; [95%CI 1.07, 1.80] P = 0.012), creatinine (OR = 1.40; [95%CI 1.06, 1.84] P = 0.018), and proteinuria (OR = 1.74; [95%CI 1.13, 1.69] P = 0.012), but not A1C (OR = 1.17; [95% CI 0.80, 1.72] P = 0.43). Rates of control of A1C and LDL cholesterol were similar in the two groups. There were no differences in blood pressure, body mass index, or functional status.


A chronic disease registry and decision support system based on easily obtainable laboratory data was feasible and acceptable to patients and providers. This system improved the process of laboratory monitoring in primary care, but not physiologic control.


diabetes mellitus decision support systems, clinical patient care management chronic disease health services research primary health care human randomized controlled trial adult