Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial.

BACKGROUND Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians. METHODS We randomized 11 primary care practices. Intervention practices received access to a DM-specific PHR that imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a "Diabetes Care Plan" for electronic submission to their physician prior to upcoming appointments. Active control practices received a PHR to update and submit family history and health maintenance information. All patients attending these practices were encouraged to sign up for online access. RESULTS We enrolled 244 patients with DM (37% of the eligible population with registered online access, 4% of the overall population of patients with DM). Study participants were younger (mean age, 56.1 years vs 60.3 years; P < .001) and lived in higher-income neighborhoods (median income, $53,784 vs $49,713; P < .001) but had similar baseline glycemic control compared with nonparticipants. More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; P < .001) compared with active controls. However, there were no significant differences in risk factor control between study arms after 1 year (P = .53). CONCLUSIONS Previsit use of online PHR linked to the EMR increased rates of DM-related medication adjustment. Low rates of online patient account registration and good baseline control among participants limited the intervention's impact on overall risk factor control. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00251875.

[1]  Sandeep Vijan,et al.  The relationship between knowledge of recent HbA1c values and diabetes care understanding and self-management. , 2005, Diabetes care.

[2]  Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. , 1996 .

[3]  R. Holman,et al.  Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. , 1998 .

[4]  S H Kaplan,et al.  Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. , 1988, Journal of general internal medicine.

[5]  Terje R Pedersen,et al.  Cholesterol Lowering With Simvastatin Improves Prognosis of Diabetic Patients With Coronary Heart Disease: A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S) , 1997, Diabetes Care.

[6]  Shari Bolen,et al.  A systematic review of interactive computer-assisted technology in diabetes care , 2006, Journal of General Internal Medicine.

[7]  David W. Bates,et al.  White Paper: Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption , 2006, J. Am. Medical Informatics Assoc..

[8]  Gary L. Kreps,et al.  Bridging the digital divide: reaching vulnerable populations. , 2004, Journal of the American Medical Informatics Association : JAMIA.

[9]  H Garth McKay,et al.  The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results. , 2003, Preventive medicine.

[10]  S. Saydah,et al.  Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes , 2004 .

[11]  M. Ravid,et al.  Teaching patients to monitor their risk factors retards the progression of vascular complications in high‐risk patients with Type 2 diabetes mellitus—a randomized prospective study , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[12]  D. Petitti,et al.  A patient-held minirecord to promote adult preventive care. , 1992, The Journal of family practice.

[13]  B. Davis,et al.  Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. , 1996, JAMA.

[14]  R. C. Turner,et al.  The effect of patient-carried reminder cards on the performance of health maintenance measures. , 1990, Archives of internal medicine.

[15]  R. Holman,et al.  Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) , 1998, The Lancet.

[16]  Justin Starren,et al.  Patient Participation in Electronic Medical Records , 2001 .

[17]  Amy Butros,et al.  Research Paper: Giving Patients Access to Their Medical Records via the Internet: The PCASSO Experience , 2002, J. Am. Medical Informatics Assoc..

[18]  J. Meigs,et al.  Low rates of medical regimen change , 2005 .

[19]  Anne F. Kittler,et al.  Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients. , 2004, Informatics in primary care.

[20]  C. Jackson,et al.  A systematic review of interactive computer-assisted technology in diabetes care: interactive information technology in diabetes care , 2006 .

[21]  M. Engelgau,et al.  A Diabetes Report Card for the United States: Quality of Care in the 1990s , 2002, Annals of Internal Medicine.

[22]  Hee-Seung Kim,et al.  Long-Term Effect of the Internet-Based Glucose Monitoring System on HbA1c Reduction and Glucose Stability , 2006, Diabetes Care.

[23]  D. Robbins,et al.  Impact of computer-generated personalized goals on HbA(1c). , 2002, Diabetes care.

[24]  M. Funnell,et al.  Patient Empowerment: Results of a randomized controlled trial , 1995, Diabetes Care.

[25]  Betty A Levine,et al.  Web-based care management in patients with poorly controlled diabetes. , 2005, Diabetes care.

[26]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness. , 2002, JAMA.

[27]  David W. Bates,et al.  A Patient-Controlled Journal for an Electronic Medical Record: Issues and Challenges , 2004, MedInfo.

[28]  Justin Starren,et al.  Research Paper: A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus , 2006, J. Am. Medical Informatics Assoc..

[29]  Oluf Pedersen,et al.  Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. , 2003, The New England journal of medicine.

[30]  Richard W Grant,et al.  Impact of population management with direct physician feedback on care of patients with type 2 diabetes. , 2003, Diabetes care.

[31]  J. Perlin,et al.  Improving the Outcomes of Metabolic Conditions: Managing Momentum To Overcome Clinical Inertia , 2006, Annals of Internal Medicine.

[32]  M. Chin,et al.  Considerations for diabetes translational research in real-world settings. , 2003, Diabetes care.

[33]  D. Bates,et al.  Electronic health record use and the quality of ambulatory care in the United States. , 2007, Archives of internal medicine.

[34]  H. Mcdonald,et al.  Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. , 2005, JAMA.

[35]  Blackford Middleton,et al.  Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care. , 2006, Diabetes technology & therapeutics.