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

Abstract

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.

Figure 1

Flowchart of a clinic-randomized trial comparing type 2 diabetes mellitus (DM) management among patients receiving access to a DM and medications personal health record (intervention arm) vs a family history and health maintenance personal health record (active control arm). Eligible participants had DM and an active Patient Gateway (PG) account for secure Internet access within the health network.

Figure 2

Proportion of follow-up visits with diabetes mellitus–related medication changes among patients who submitted personal health record journals to their physician's electronic medical record (“on-treatment analysis” comparing intervention and control arms).