• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (19)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Informatics/ Internet in Medicine  • Internet  • Informatics, Other  • Cardiovascular System, Other  • Nutritional and Metabolic Disorders  • Lipids and Lipid Disorders  • Cardiovascular System  • Endocrine Diseases  • Diabetes Mellitus  • Alert me on articles by topic  Social Bookmarking   What's this?

A Randomized Controlled Trial

Richard W. Grant, MD, MPH; Jonathan S. Wald, MD; Jeffrey L. Schnipper, MD, MPH; Tejal K. Gandhi, MD, MPH; Eric G. Poon, MD, MPH; E. John Orav, PhD; Deborah H. Williams, MHA; Lynn A. Volk, MHS; Blackford Middleton, MD, MPH, MSc

Arch Intern Med. 2008;168(16):1776-1782.

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

Author Affiliations: Divisions of General Medicine, Massachusetts General Hospital (Dr Grant), Brigham and Women's Hospital (Drs Schnipper, Gandhi, Poon, Orav, and Middleton and Ms Williams), and Harvard Medical School (Drs Grant, Schnipper, Gandhi, Poon, Orav, and Middleton), Boston; and Clinical Informatics Research and Development (Drs Wald, Poon, and Middleton) and Clinical and Quality Analysis (Mss Williams and Volk), Partners Information Systems, Wellesley, Massachusetts.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

In This Issue of Archives of Internal Medicine
Arch Intern Med. 2008;168(16):1730.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials
McKibbon et al.
J Am Med Inform Assoc 2012;19:22-30.
ABSTRACT | FULL TEXT  

Standards of Medical Care in Diabetes--2012
Diabetes Care 2012;35:S11-S63.
FULL TEXT  

Blood pressure, lipids and glucose in type 2 diabetes: how low should we go? Re-discovering personalized care
Rutter and Nesto
Eur Heart J 2011;32:2247-2255.
ABSTRACT | FULL TEXT  

Many Physicians Are Willing To Use Patients' Electronic Personal Health Records, But Doctors Differ By Location, Gender, And Practice
Wynia et al.
Health Aff (Millwood) 2011;30:266-273.
ABSTRACT | FULL TEXT  

Potential for Electronic Health Records and Online Social Networking to Redefine Medical Research
Pearson et al.
Clin. Chem. 2011;57:196-204.
ABSTRACT | FULL TEXT  

Impact of Electronic Health Record Clinical Decision Support on Diabetes Care: A Randomized Trial
O'Connor et al.
Ann Fam Med 2011;9:12-21.
ABSTRACT | FULL TEXT  

Health Information Technology and Quality of Health Care: Strategies for Reducing Disparities in Underresourced Settings
Millery and Kukafka
Med Care Res Rev 2010;67:268S-298S.
ABSTRACT  

Implementing practice-linked pre-visit electronic journals in primary care: patient and physician use and satisfaction
Wald et al.
J Am Med Inform Assoc 2010;17:502-506.
ABSTRACT | FULL TEXT  

Technology and Patient-Provider Interactions: Improving Quality of Care, But Is It Improving Communication and Collaboration?
Boucher
Diabetes Spectr. 2010;23:142-144.
FULL TEXT  

Who Will Care for Me Next? Transitioning to Adulthood With Hydrocephalus
Simon et al.
Pediatrics 2009;124:1431-1437.
ABSTRACT | FULL TEXT