Incentives for diabetes decisions

Patients are being encouraged to have electronic health records. To find out how electronic decision support can improve care, a research group in Minnesota has carried out a randomised trial in patients with diabetes.

The study included 2566 patients, attending 11 primary healthcare clinics.  All the clinics had electronic health records, but six also used a decision support system for type 2 diabetes. This system gave the doctors advice derived from evidence-based guidelines.

During the six months of the study, the doctors using the system intensified the patients’ treatment in 62% of the instances where HbA1c was over 7%. They intensified antihypertensive therapy during 44% of the visits when the blood pressure exceeded the target range.

At the start of the study the patients in each group had similar HbA1c levels. Following the intervention, the levels were significantly reduced in the patients attending the clinics with the decision support system. 

COMMENT

Although the system reduced HbA1c levels, there was also an improvement in the control group. The difference between the groups at the end of the study was 0.26%. There was no significant difference in the proportion of patients achieving HbA1c under 7%. Mean blood pressure was also not significantly different between the groups.

Whether the modest improvements attributable to decision support were sustainable is questionable. The system was actively promoted during the intervention with the doctors being paid up to US$1600 ($1550) for using it. Usage dropped substantially after the incentives were removed.

Dr John Dowden, Canberra 

O’Connor, PJ et al. Impact of electronic health record clinical decision support on diabetes care. Annals of Family Medicine 2011;9:12-21