Post on 26-Dec-2015
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Development and evaluation of an electronic feedback system,
a tool for optimizing diabetes care in general practice.
T.L. Guldberg(1), P. Vedsted(2), J.K. Kristensen(1), V. Zoffmann(3), T. Lauritzen(1)
Institute of Public Health, Aarhus University
1)Dept. of General Practice 2)Research Unit for General Practice,3) Steno Diabetes center
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Aim:
To evaluate the effect of an electronic feedback system to GPs
concerning their type 2-diabetes care in a randomized intervention design.
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Intervention:
90 general practitioners clinics have been randomised to either admission
or no admission to an electronic feedback system.
GPs cared for 5148 people with type 2-diabetes
Intervention nested in Region Syddanmark and Region Midtjylland.
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Electronic feedback system:
Distributed on CD Rom,
Initially installed by visiting project worker.
Updated quarterly.
Launched in 2007 and ran for one year.
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Evaluation:
Quantitative evaluation on register data and log data
Qualitative evaluation on interview data with intervention GPs
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Primary output:
Usage of the electronic feedback system
• Used at overall level?
• Used at individual patient level?
Impact of system in intervention clinics
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
InitialLog data
Interview data
Intermediate
Interview data
Long term
Register data:
• Data on laboratory
tests
• Data on medicinal
use
• Data on diabetes-
related eye
examinations
Interview data
Outcome
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
InitialGPs used the sortable lists to get an overview of the patient population.
Interview data
Intermediate
Interview data
Long term
Register data:
• Data on laboratory
tests
• Data on medicinal
use
• Data on diabetes-
related eye
examinations
Interview data
Outcome
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
InitialGPs used the sortable lists to get an overview of the patient population.
The lists generated attention to problem areas in the diabetes care.
Intermediate
Interview data
Long term
Register data:
• Data on laboratory
tests
• Data on medicinal
use
• Data on diabetes-
related eye
examinations
Interview data
Outcome
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
InitialGPs used the sortable lists to get an overview of the patient population.
The lists generated attention to problem areas in the diabetes care.
IntermediateIncreased attention led to :
• Organisational changes in two of four GP clinics
• Additional education of practice nurses
• Allocation of diabetes care to practice nurses,
Long term
Register data:
• Data on laboratory
tests
• Data on medicinal
use
• Data on diabetes-
related eye
examinations
Interview data
Outcome
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
InitialGPs used the sortable lists to get an overview of the patient population.
The lists generated attention to problem areas in the diabetes care.
IntermediateIncreased attention led to :
• Organisational changes in two of four GP clinics
• Additional education of practice nurses
• Allocation of diabetes care to practice nurses,
Long termIntervention GPs have more:• Cholesterol controls
(p=0,036)• Patient eye
examinations (p=0,005)
• Use of statins (p=0,016), metformin (p=0,004) and ACE inhibitors (p=0,008)
Interview data
Outcome
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
InitialGPs used the sortable lists to get an overview of the patient population.
The lists generated attention to problem areas in the diabetes care.
IntermediateIncreased attention led to :
• Organisational changes in two of four GP clinics
• Additional education of practice nurses
• Allocation of diabetes care to practice nurses,
Long termIntervention GPs have more:• Cholesterol controls
(p=0,036)• Patient eye
examinations (p=0,005)
• Use of statins (p=0,016), metformin (p=0,004) and ACE inhibitors (p=0,008)
• GPs felt liberated by allocating diabetes care to nurses,
• GPs spend more time on other patient groups.
Outcome
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Problems discovered:
No usage on individual patient level due to:
• No real time data
• Practice in-house IT systems superior in data and familiar to use.
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Perspectives:
• An electronic feedback system containing sortable lists generated new
insight into the quality of diabetes care in GP clinics
• New attention to quality of diabetes care led to organisational changes
in GP clinics, allocating diabetes care to practice nurses.
• An electronic feedback system led to better quality of care for people
with Type 2-Diabetes in general practice.
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TRINE LIGNELL GULDBERG 14 MAY, 2009
DEPT. OF GENERAL PRACTICESCHOOL OF PUBLIC HEALTHAARHUS UNIVERSITY
Thank you.