Development and evaluation of an electronic feedback system,

1. Development and evaluation of an electronic feedback system, a tool for optimizingdiabetes 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

2. Aim: To evaluate the effect of an electronic feedback system to GPs concerning their type 2-diabetes care in a randomized intervention design.

3. 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.

4. Electronic feedback system: Distributed on CD Rom, Initially installed by visiting project worker. Updated quarterly. Launched in 2007 and ran for one year.

8. Evaluation: Quantitative evaluation on register data and log data Qualitative evaluation on interview data with intervention GPs

9. Primary output: • Usage of the electronic feedback system • Used at overall level? • Used at individual patient level? • Impact of system in intervention clinics

10. Long term • Register data: • Data on laboratory tests • Data on medicinal use • Data on diabetes-related eye examinations • Interview data Outcome Intermediate Interview data Initial Log data Interview data

11. Long term • Register data: • Data on laboratory tests • Data on medicinal use • Data on diabetes-related eye examinations • Interview data Outcome Intermediate Interview data Initial GPs used the sortable lists to get an overview of the patient population. Interview data

12. Long term • Register data: • Data on laboratory tests • Data on medicinal use • Data on diabetes-related eye examinations • Interview data Outcome Intermediate Interview data Initial GPs used the sortable lists to get an overview of the patient population. The lists generated attention to problem areas in the diabetes care.

13. Long term • Register data: • Data on laboratory tests • Data on medicinal use • Data on diabetes-related eye examinations • Interview data Outcome • Intermediate • Increased attention led to : • Organisational changes in two of four GP clinics • Additional education of practice nurses • Allocation of diabetes care to practice nurses, Initial GPs used the sortable lists to get an overview of the patient population. The lists generated attention to problem areas in the diabetes care.

14. Long term • Intervention 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 • Intermediate • Increased attention led to : • Organisational changes in two of four GP clinics • Additional education of practice nurses • Allocation of diabetes care to practice nurses, Initial GPs used the sortable lists to get an overview of the patient population. The lists generated attention to problem areas in the diabetes care.

15. Long term • Intervention 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 • Intermediate • Increased attention led to : • Organisational changes in two of four GP clinics • Additional education of practice nurses • Allocation of diabetes care to practice nurses, Initial GPs used the sortable lists to get an overview of the patient population. The lists generated attention to problem areas in the diabetes care.

16. 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.

17. 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.

18. Thank you.