Use of a Registry-generated Audit, Feedback, and Patient Reminder Intervention in an Internal Medicine Resident Clinic—A Randomized Trial
文摘
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 2003-004 academic year. PARTICIPANTS Seventy-eight categorical Internal Medicine residents caring for 483 diabetic patients participated. Residents randomized to the intervention (n--9) 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--9) 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.