Physician Performance Feedback Improves Diabetes Control

A computerized system that tells primary care physicians how well they are managing blood glucose levels in their patients seems to improve diabetes control, new research suggests.

Proper blood glucose control can improve diabetes outcomes and numerous treatment guidelines drive home this point, yet HbA1c levels in diabetics in the US are rising. This trend may reflect "clinical inertia," meaning that clinicians are not intensifying diabetes therapy when indicated.

In a 3-year study, Dr. Lawrence S. Phillips, from Emory University Hospital in Atlanta, and colleagues evaluated computerized performance feedback as a means of overcoming clinical inertia among 345 mostly white internal medicine residents treating a predominantly African American population. The majority of the physicians were men, while most of the patients were women. A total of 4038 diabetics seen by the residents in a primary care setting were included in the analysis.

The residents were randomized to a usual care group or to groups that received computerized reminders, feedback or both regarding blood glucose management in their patients. When blood glucose levels exceeded 150 mg/dL, the residents’ behavior was characterized as "did nothing," "did anything" (any intensification of therapy), or "did enough" (intensification met recommendations).

Prior to the interventions, "did anything" and "did enough" behaviors were noted in 35% and 21% of visits, respectively.
The interventions that incorporated performance feedback were better at intensifying diabetes therapy than were the usual care or reminder alone interventions. By the end of the study, the behavior patterns noted with the latter two interventions had returned to baseline, whereas sustained improvements were noted with both performance feedback interventions: 52% "did anything" and 30% "did enough" (p < 0.001).

Multivariate analysis confirmed that performance feedback was independently predictive of treatment intensification, which, in turn, was independently tied to a drop in HbA1c levels.

"To the extent that limitations in healthcare provider behavior — clinical inertia — constitute a major barrier to diabetes management, our model may have broad application to improve patient outcomes and to decrease the clinical and economic impact of diabetes in the primary care setting," the authors conclude.
Arch Intern Med 2006;166:507-513.

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