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

  • Charles D. MacLean
  • Michael Gagnon
  • Peter Callas
  • Benjamin Littenberg
Original Article

Abstract

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS

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

INTERVENTIONS

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).

MEASUREMENTS AND MAIN RESULTS

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.

CONCLUSIONS

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.

KEY WORDS

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

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Charles D. MacLean
    • 1
  • Michael Gagnon
    • 2
  • Peter Callas
    • 3
  • Benjamin Littenberg
    • 1
    • 4
  1. 1.Division of General Internal MedicineUniversity of Vermont College of MedicineBurlingtonUSA
  2. 2.Department of Information ServicesFletcher Allen Health CareBurlingtonUSA
  3. 3.Department of BiometryUniversity of VermontBurlingtonUSA
  4. 4.Department of NursingUniversity of VermontBurlingtonUSA

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