Use of a registry-generated audit, feedback, and patient reminder intervention in an internal medicine resident clinic - A randomized trial

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.