An interactive web-based management system may improve diabetes care by doctors

Demiris, George PhD

Health Management and Informatics; School of Medicine; University of Missouri-Columbia

Abstracted from:Meigs J B, Cheuh H, Cagliero E et al. A controlled trial of Web-based diabetes disease management, The MGH Diabetes Primary Care Improvement Project. Diabetes Care 2003; 26: 750-775 .

Sources of funding: This study was supported by a grant from the National Pharmaceutical Council and by the MGH Primary Care Operations Improvement and Clinical Research Programs. Funds for dissemination of results were also provided by Aventis Pharmaceuticals. J.B.M. received support from an American Diabetes Association clinical research grant and a junior faculty development grant from Smith Kline Beecham.

Correspondence to: J B. Meigs, General Medicine Division, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA 02114. Email: [email protected].

Abstract provided by Bazian Ltd, London

Evidence-based Healthcare 7(3):p 119-121, September 2003.

BACKGROUND

Simple screening interventions to prevent diabetic complications are not always implemented by physicians. Reasons include inadequate knowledge of current evidence-based care and time constraints. Interactive computerized decision support systems may have more potential than guidelines and traditional physician education in improving diabetes care. Few have been tested in rigorously controlled trials or in settings outside HMOs. Furthermore, most studies have focused on the prevention of microvascular disease, whereas macrovascular complications are a greater health burden.

OBJECTIVE

To test effects on diabetes care of a new web-based decision support tool, the diabetes Disease Management Application (DMA).

SETTING

US hospital-based staff-resident primary care internal medicine clinic, May 1998 to April 1999.

METHOD

Randomized controlled trial.

PARTICIPANTS

Twenty-six staff providers; 598 people with type 2 diabetes.

INTERVENTION

A web-based decision support tool, the diabetes Disease Management Application (DMA) compared with no tool. The decision support tool allowed interaction with patient-specific clinical data, treatment advice, and links to other web-based care resources. The intervention group could use the DMA as they wished.

MAIN OUTCOMES

HbA_1c, LDL cholesterol, blood pressure, eye and foot problems; provider use of the DMA.

MAIN RESULTS

In the intervention group, the DMA was used for 42% of scheduled patient visits. There was a significantly greater increase in the intervention group compared with the control group in the number of HbA_1c tests (+0.3 versus −0.04 tests/year, p=0.008), the number of LDL cholesterol tests (+0.2 versus +0.01 tests/year; p=0.02) and foot examinations (+9.8 versus −0.7%, p=0.003). There was no significant difference in LDL nor HbA_1c.

AUTHORS' CONCLUSIONS

Web-based decision support tools that are able to tailor decisions to individual patients may improve the processes and outcomes of diabetes care. However, effects in this trial may have been modest because of inconsistent use of the tool by health-care providers.