Research and Projects: AHRQ THQIT and SRD Portfolio

Ohio

Trial of Decision Support to Improve Diabetes Outcomes

Description:  Evaluates the effects of a Web portal-based patient empowerment program and EMR system on quality of care, patient safety, and utilization for patients with diabetes and physicians in primary care practices.

Abstract:  DESCRIPTION: (PROVIDED BY APPLICANT): Diabetes is an independent risk factor for the nation's first and third leading killers and the leading cause of kidney failure and adult blindness. Evidence-based guidelines exist for control of glycemia (A1c levels), lipid abnormalities (LDL levels), hypertension (HBP), kidney and eye disease, yet gaps exist between what can be achieved and current performance. Competing approaches to improvement include disease management and patient empowerment, both of which can be facilitated by electronic medical records (EMR)-centered decision support. Aims and Methods: The investigation is a 2-year cluster-randomized trial of 22 primary cafe practices, 197 PCPs, and their 13,000 adult diabetics across two health systems experienced in using the same commercial EMR system. Four clusters of similar practices will be assigned randomly to EMR-based disease management (EMR-DM 2). web portal-based patient empowerment (EMR-PE), both approaches (EMR-Both). or EMR alone. Our Aims are to: 1) compare the incremental effects of our interventions on primary outcomes (quality of care/patient safety, and utilization), adjusting as necessary for baseline prognostic differences, adjusting for clustering and using an intention-to-treat analysis; 2) estimate intervention effects in pre-specified sub-groups: 3) describe specific features of patients and PCPs that are associated with different types and levels of adoption of our interventions; and 4) describe general and intervention-specific unintended consequences of our interventions. Significance: The results of this investigation will be of critical value to providers and their patients with chronic illnesses, to payers and insurers, to policymakers, and to those seeking to better understand EMR-based decision support - its adoption, and its usefulness for improving quality and safety in patient care. CCF Partnership: CCF investigators Harris, Miller, and Jain will collaborate on all aspects of this project. CCF will lead the components of the study related to patient empowerment utilizing the MyChart clinical application currently being deployed at CCF.

Year 1 Funding:  $499,766

Estimated Total Funding:  $1,495,569

Principal Investigator:  Randall Cebul

Applicant Institution:  Case Western Reserve University

City/Town:  Cleveland, Ohio

State:  Ohio

Grant Number:  R01 HS15123

Category:  Value Grants (THQIT)

Thesaurus Terms:  automated medical record system, clinical trial, computer assisted medical decision making, diabetes mellitus therapy, health care personnel performance, health care service evaluation, patient care management, Internet, blood chemistry, comorbidity, health behavior, health care quality, health care service utilization, low socioeconomic status, patient safety /medical error, racial /ethnic difference, satisfaction, therapy adverse effect, behavioral /social science research tag, clinical research, health services research tag, human data, human subject, patient oriented research, questionnaire

Project Start Date:  Sep 30, 2004

Project End Date:  Aug 31, 2007