A web-based diabetes intervention for physician: a cluster-randomized effectiveness trial

作者：Estrada Carlos A^*; Safford Monika M; Salanitro Amanda H; Houston Thomas K; Curry William; Williams Jessica H; Ovalle Fernando; Kim Yongin; Foster Pamela; Allison Jeroan J

来源：International Journal for Quality in Health Care, 2011, 23(6): 682-689.

DOI：10.1093/intqhc/mzr053

• internet
• translational research
• diabetes mellitus
• rural health services
• education
• medical
• continuing process assessment (Health Care)

To determine the effectiveness of a provider-based education and implementation intervention for improving diabetes control.
Cluster-randomized trial with baseline and follow-up cross sections of diabetes patients in each participating physicians practice.
Eleven US Southeastern states, 200608.
Two hundred and five rural primary care physicians.
Multi-component interactive intervention including Web-based continuing medical education, performance feedback and quality improvement tools.
oAcceptable control' [hemoglobin A1c 9, blood pressure (BP) 140/90 mmHg, low-density lipoprotein cholesterol (LDL) 130 mg/dl] and ooptimal control' (A1c 7, BP 130/80 mmHg, LDL 100 mg/dl).
Of 364 physicians attempting to register, 205 were randomized to the intervention (n 102) or control arms (n 103). Baseline and follow-up data were provided by 95 physicians (2127 patients). The proportion of patients with A1c 9 was similar at baseline and follow-up in both the control [adjusted odds ratio (AOR): 0.94; 95 confidence interval (CI): 0.61, 1.47] and intervention arms [AOR: 1.16 (95 CI: 0.80, 1.69)]; BP 140/90 mmHg and LDL 130 mg/dl were also similar at both measurement points (P 0.66, P 0.46; respectively). We observed no significant effect on diabetes control attributable to the intervention for any of the primary outcome measures. Intervention physicians engaged with the Website over a median of 64.7 weeks [interquartile range (IQR): 45.481.8) for a median total of 37 min (IQR: 1666).
A wide-reach, low-intensity, Web-based interactive multi-component intervention did not improve control of glucose, BP or lipids for patients with diabetes of physicians practicing in the rural Southeastern US.

• 出版日期2011-12