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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.

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