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

J Gen Intern Med. 2007 Dec;22(12):1740-4. doi: 10.1007/s11606-007-0431-x. Epub 2007 Nov 1.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Commission on Professional and Hospital Activities*
  • Continuity of Patient Care
  • Diabetes Mellitus / therapy*
  • Feedback
  • Female
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Internal Medicine / education
  • Internal Medicine / standards*
  • Internship and Residency / standards*
  • Male
  • Outcome and Process Assessment, Health Care
  • Outpatient Clinics, Hospital
  • Program Evaluation
  • Registries
  • Reminder Systems*