Journal of General Internal Medicine

, Volume 22, Issue 12, pp 1740–1744

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

  • Kris G. Thomas
  • Matthew R. Thomas
  • Robert J. Stroebel
  • Furman S. McDonald
  • Gregory J. Hanson
  • James M. Naessens
  • Todd R. Huschka
  • Joseph C. Kolars
Original Article

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.

KEY WORDS

education, medical health care quality diabetes mellitus outcome assessment registries 

References

  1. 1.
    Institute of Medicine. Crossing the Quality Chasm. Washington, DC: National Academy Press; 2001.Google Scholar
  2. 2.
    McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.PubMedCrossRefGoogle Scholar
  3. 3.
    Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64–78.CrossRefGoogle Scholar
  4. 4.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA. 2002;288(15):1909–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Schmittdiel J, Bodenheimer T, Solomon NA, Gillies RR, Shortell SM. Brief report: the prevalence and use of chronic disease registries in physician organizations. A national survey. J Gen Intern Med. 2005;20(9):855–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Jamtvedt G, Young JM, Kristoffersen DT, Thomson O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2003(3):CD000259.Google Scholar
  7. 7.
    Demakis JG, Beauchamp C, Cull WL, et al. Improving residents’ compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders. JAMA. 2000;284(11):1411–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Shea S, DuMouchel W, Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996;3(6):399–409.PubMedGoogle Scholar
  9. 9.
    Renders CM, Valk GD, Griffin S, Wagner EH, Eijk JT, Assendelft WJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database Syst Rev. 2004(1):CD001481.Google Scholar
  10. 10.
    Stroebel RJ, Scheitel SM, Fitz JS, et al. A randomized trial of three diabetes registry implementation strategies in a community internal medicine practice. Jt Comm J Qual Improv. 2002;28(8):441–50.PubMedGoogle Scholar
  11. 11.
    Mosser G. Clinical process improvement: engage first, measure later. Qual Manag Health Care. 1996;4(4):11–20.PubMedGoogle Scholar
  12. 12.
    Diggle P, Heagerty P, Liang K, Zeger S. Analysis of Longitudinal Data. 2 ed. Oxford, England: Oxford University Press; 2002.Google Scholar
  13. 13.
    Liang KY, Zeger SL. Regression analysis for correlated data. Annu Rev Public Health. 1993;14:43–68.PubMedCrossRefGoogle Scholar
  14. 14.
    Holmboe ES, Prince L, Green M. Teaching and improving quality of care in a primary care internal medicine residency clinic. Acad Med. 2005;80(6):571–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Kern DE, Harris WL, Boekeloo BO, Barker LR, Hogeland P. Use of an outpatient medical record audit to achieve educational objectives: changes in residents’ performances over six years. J Gen Intern Med. 1990;5(3):218–24.PubMedCrossRefGoogle Scholar
  16. 16.
    Holmboe E, Scranton R, Sumption K, Hawkins R. Effect of medical record audit and feedback on residents’ compliance with preventive health care guidelines. Acad Med. 1998;73(8):901–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Gould BE, Grey MR, Huntington CG, et al. Improving patient care outcomes by teaching quality improvement to medical students in community-based practices. Acad Med. 2002;77(10):1011–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Denton GD, Smith J, Faust J, Holmboe E. Comparing the efficacy of staff versus housestaff instruction in an intervention to improve hypertension management. Acad Med. 2001;76(12):1257–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Kogan JR, Reynolds EE, Shea JA. Effectiveness of report cards based on chart audits of residents’ adherence to practice guidelines on practice performance: a randomized controlled trial. Teach Learn Med. 2003;15(1):25–30.PubMedCrossRefGoogle Scholar
  20. 20.
    Chaudhry R, Scheitel SM, McMurtry EK, Leutink DJ, Cabanela RL, Naessens JM, Rahman AS, Davis LA, Stroebel RJ. Web-based proactive system to improve breast cancer screening: a randomized controlled trial. Arch Intern Med. 2007;167(6):606–11.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Kris G. Thomas
    • 1
  • Matthew R. Thomas
    • 1
  • Robert J. Stroebel
    • 1
  • Furman S. McDonald
    • 1
  • Gregory J. Hanson
    • 1
  • James M. Naessens
    • 2
  • Todd R. Huschka
    • 2
  • Joseph C. Kolars
    • 1
  1. 1.Department of MedicineMayo Clinic College of MedicineRochesterUSA
  2. 2.Division of Health Care Policy and ResearchMayo Clinic College of MedicineRochesterUSA

Personalised recommendations