Diabetes Mellitus
Conditions
Keywords
Self Monitoring of Blood Glucose, Electronic Medical Records, Nudge, Secure Messaging, Behavioral Economics
Brief summary
This multi-site randomized tral aims to test methods of increasing adoption and integration of blood glucose monitoring into electronic medical records, and to measure the impact of wide-scale adoption on health status of patients with diabetes. To investigate determinants of adoption, the research will combine and test doctor and patient focused approaches to encouraging patient use of blood glucose flow sheets through the online patient portal, MyChart. Adoption will be measured on both the extensive and intensive margin: the number of patients who enter data into the flowsheets at all during the study period, and the mean number of entries per patient during the study period. Conditional on statistically significant increases in adoption, the study will examine corresponding intent-to-treat effects on patient A1c, and consider other indicators of possible mechanisms through which A1c improves or does not improve.
Interventions
BEHAVIORALPractice Orientation
Practices will be encouraged to batch order blood glucose flowsheets for all patients with diabetes with active MyChart accounts. This will allow diabetic patients at these practices to enter any self-monitored glucose measurements. The research team will contact physicians and practice managers with an explanation of the initiative and instructions for completing batch orders and viewing entries through the system. Additionally, providers will be given a template for a secure smart-text message to send to all patients receiving the flowsheets, instructing them to enter data for the study period. The secure message will also provide them with information on how to enter data, and on the benefits of tracking blood glucose.
BEHAVIORALStandard Reminder
Patients receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
BEHAVIORALGift Card Reminder
Patients receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets. In these reminders, they will also be notified that that they will be entered to win a $50 gift card for each day entering data.
BEHAVIORALPhysician Reminders
Patients receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT)
Sponsors
University of California, Berkeley
Abdul Latif Jameel Poverty Action Lab
General Services Administration (GSA)
Department of Health and Human Services
Inova Health Care Services
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Primary care practices will be assigned to a provider-side treatment (physician orientation) or to control. Within treatment assigned practices, individual patients will be assigned to one of four reminder messaging groups (one of which is no messaging).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adult patients of Inova physicians at primary care sites other than Ashburn II Primary Care, Lake Ridge Primary Care and Springfield Primary Care * Current diabetes mellitus diagnosis * Active MyChart account at time of treatment administration
Exclusion criteria
* Patients who participating physicians identify as pregnant * Patients who participating physicians identify as having contraindications for tracking of blood glucose
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | (1-14) weeks after initial practice orientation | Count of participants that entered data to an electronic glucose flowsheet during the measurement period (Count of participants determined with a binary aggregation method; 1= Participant used Flow Sheet at least once during measurement period; 0= Participant did not use Flow Sheet during Measurement Period) |
| Participant A1c Test Results (as Percent A1c) at 26 Weeks | 26 weeks after initial practice orientation | Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. The most recent and available HbA1c test value (percent A1c) in electronic medical records at appropriate time period was used. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | at 14 and 26 weeks after initial practice orientation | Count of participants that have an open physician order for electronic glucose flowsheet end of the measurement period (Count of participants determined with a binary aggregation method; 1= Participant had an open physician order for electronic Glucose Flow Sheet at end of measurement period; 0= Participant did not have an open physician order for electronic Glucose Flow Sheet at end of measurement period) |
| Number of Days Since Last HbA1c Test | 14; 26 weeks after initial practice orientation | The total number of days that elapsed since participant last had and HbA1c test. The number of days was measured by the number of days that passed from the date of the most recent HbA1c test in the Electronic Medical Record and the date of the data extraction at the specified time point. |
| Participant A1c Test Results (as Percent A1c) at 14 Weeks | 14 weeks after initial practice orientation | Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. The most recent and available HbA1c test value (percent A1c) in electronic medical records at appropriate time period was used |
| Count of Participants With Improvement of HbA1c Test Results | 14; 26 weeks after initial practice orientation | Count of participants with improved HbA1c test result values in most recent Electronic Medical Record (EMR) during measurement period as compared to HbA1c test value at baseline. (Count of participants determined with a binary aggregation method; 1= Participant Improved, most recent A1c test value less than baseline A1c test value; 0= Participant did not Improve; most recent A1c test value greater than or equal to baseline A1c test value) Improvement of HbA1c test results is defined as a reduction of the most recent and available HbA1c test value (a lower percent A1c) in the EMR at appropriate time period relative to the baseline. Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. Higher percent A1c levels are associated with poor blood sugar control and increased risk of of diabetes-related complications. |
| Count of Participants With Percent A1c Below Benchmark of 7 | 14; 26 weeks after initial practice orientation | Count of participants with most recent HbA1c test value (percent A1c) in Electronic Medical Records below target benchmark of 7 at appropriate time point (Count of participants determined with a binary aggregation method; 1= Participant HbA1c test value less than 7; 0= Participant Hb1Ac test value greater than or equal to 7). Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. A percent A1c level less than 7 is a common treatment target and is associated with with a lower risk of diabetes-related complications. |
| Total Secure Messages Sent by Participant | (1-14); (15-26) weeks after initial practice orientation | Total number of messages sent by participant via MyChart Electronic medical records system during the measurement period |
| Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | Beginning of week 15 to 26 weeks after initial practice orientation | Count of participants that entered data to an electronic glucose flowsheet during the measurement period (Count of participants determined with a binary aggregation method; 1= Participant used Flow Sheet at least once during measurement period; 0= Participant did not use Flow Sheet during Measurement Period) |
| Total Secure Messages Sent by PCP to Patient | (1-14); (15-26) weeks after initial practice orientation | Total number of MyChart messages sent by PCP to the patient during the measurement period |
| Total Number of Participant Phone Appointments | (1-14); (1-26) weeks after initial practice orientation | Total number of participant phone appointments during the measurement period |
| Total Number of Participant In-person Appointments | (1-14); (1-26) weeks after initial practice orientation | Total number of participant in-person appointments during the measurement period |
| Count of Participants With Changes to Active Medication List | (1-14); (1-26) weeks after initial practice orientation | Count of Participants with Changes (Any; Addition; Removal) to list of active medications in EMR during measurement period. Active medication lists is comprised of prescription ordered medications for participants. Count of participants determined with a binary aggregation method: Any Change is defined as medications added or removed from active list ( 1= Participant had medications added to or removed from active medication list; 0= Participant did not have medication added to or removed from active medication list). Medications Added is defined as the addition of medications to active medication list ( 1= Participant had medications added to active medication list; 0= Participant did not have medications added to active medication list). Medications Removed is defined as the removal of medications to active medication list ( 1= Participant had medications removed from active medication list; 0= Participant did not have medications removed from active medication list). |
| Prescription Orders | (1-14); (1-26) weeks after initial practice orientation | Number of prescription ordered medications for participant during measurement period (Total all; Total new/non-refill; Total diabetes related) |
| Flowsheet Entry Values (Descriptive) | 2; 4; 6; 8; 10; 12; 14; 18; 22; 26 weeks after initial orientation meeting | Value of blood glucose entered into flowsheet (descriptive analysis). No systematic outcomes recorded to report. |
| Total Secure Messages Sent by Patient to Primary Care Provider | (1-14); (15-26) weeks after initial practice orientation | Total number of MyChart messages sent by patient to the Primary Care Provider (PCP) during the measurement period. Not reported separately from Total number of messages sent by patient, so outcomes not reported here. |
| Number of Days Participant Used Flowsheet, Intensive | (1-14); (15-26) weeks after initial practice orientation | The total number of days of participant use of the electronic glucose flowsheet during the measurement period. A day of Participant use of electronic glucose flowsheet is defined here as as day (24 hours) in which the participant performed an entry into an electronic glucose flowsheet. |
Countries
United States
Participant flow
Pre-assignment details
20 primary care practices were randomly assigned to treatment (10 practices, 3411 patients) and control (10 practices, 3641 patients). Participants at treated primary care practices whose providers placed flow sheet orders (2182 patients total) were assigned to 1 of 4 reminder message groups to encourage utilization of the flow sheets. Assignment to reminder groups was determined alphabetically by the first letter of participant's last name.
Participants by arm
| Arm | Count |
|---|---|
| 1: Control A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual. | 3,641 |
| 2a: Participants in the Practice Orientation- No Reminder Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets. | 762 |
| 2b: Participants in the Practice Orientation- Standard Reminder Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data. | 895 |
| 2c: Participants in the Practice Orientation- Gift Card Reminder Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data. | 866 |
| 2d: Participants in the Practice Orientation- Physician Reminder Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT). | 888 |
| Total | 7,052 |
Baseline characteristics
| Characteristic | 1: Control | 2a: Participants in the Practice Orientation- No Reminder | 2b: Participants in the Practice Orientation- Standard Reminder | 2c: Participants in the Practice Orientation- Gift Card Reminder | 2d: Participants in the Practice Orientation- Physician Reminder | Total |
|---|---|---|---|---|---|---|
| Age, Continuous | 58.863 years STANDARD_DEVIATION 14 | 58.885 years STANDARD_DEVIATION 14.9 | 58.434 years STANDARD_DEVIATION 14.7 | 58.756 years STANDARD_DEVIATION 14.5 | 59.760 years STANDARD_DEVIATION 14.7 | 58.910 years STANDARD_DEVIATION 14.3 |
| Percent A1c, Baseline | 7.219 Percent A1c STANDARD_DEVIATION 1.587 | 7.327 Percent A1c STANDARD_DEVIATION 2.87 | 7.150 Percent A1c STANDARD_DEVIATION 1.543 | 7.189 Percent A1c STANDARD_DEVIATION 1.6 | 7.168 Percent A1c STANDARD_DEVIATION 1.606 | 7.212 Percent A1c STANDARD_DEVIATION 1.784 |
| Race/Ethnicity, Customized Ethnicity Hispanic | 253 Participants | 27 Participants | 62 Participants | 50 Participants | 27 Participants | 419 Participants |
| Race/Ethnicity, Customized Ethnicity Other, Unknown, or Not reported | 480 Participants | 113 Participants | 145 Participants | 112 Participants | 118 Participants | 968 Participants |
| Race/Ethnicity, Customized Ethnicity White, Non-Hispanic | 2908 Participants | 622 Participants | 688 Participants | 704 Participants | 743 Participants | 5665 Participants |
| Sex/Gender, Customized Female | 1683 Participants | 350 Participants | 401 Participants | 388 Participants | 392 Participants | 3214 Participants |
| Sex/Gender, Customized Male | 1958 Participants | 412 Participants | 494 Participants | 478 Participants | 496 Participants | 3838 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin
Count of participants that entered data to an electronic glucose flowsheet during the measurement period (Count of participants determined with a binary aggregation method; 1= Participant used Flow Sheet at least once during measurement period; 0= Participant did not use Flow Sheet during Measurement Period)
Time frame: (1-14) weeks after initial practice orientation
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 1: Control | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 4 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 27 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 44 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 43 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 50 Participants |
Primary
Participant A1c Test Results (as Percent A1c) at 26 Weeks
Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. The most recent and available HbA1c test value (percent A1c) in electronic medical records at appropriate time period was used.
Time frame: 26 weeks after initial practice orientation
Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe.~Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1: Control | Participant A1c Test Results (as Percent A1c) at 26 Weeks | 7.179 Percent A1c | Standard Deviation 1.54 |
| 2a: Practice Orientation- No Reminder | Participant A1c Test Results (as Percent A1c) at 26 Weeks | 7.327 Percent A1c | Standard Deviation 2.894 |
| 2b: Practice Orientation- Standard Reminder | Participant A1c Test Results (as Percent A1c) at 26 Weeks | 7.110 Percent A1c | Standard Deviation 1.474 |
| 2c: Practice Orientation- Gift Card Reminder | Participant A1c Test Results (as Percent A1c) at 26 Weeks | 7.227 Percent A1c | Standard Deviation 1.623 |
| 2d: Practice Orientation- Physician Reminder | Participant A1c Test Results (as Percent A1c) at 26 Weeks | 7.227 Percent A1c | Standard Deviation 1.731 |
Secondary
Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin
Count of participants that entered data to an electronic glucose flowsheet during the measurement period (Count of participants determined with a binary aggregation method; 1= Participant used Flow Sheet at least once during measurement period; 0= Participant did not use Flow Sheet during Measurement Period)
Time frame: Beginning of week 15 to 26 weeks after initial practice orientation
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| 1: Control | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 4 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 15 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 17 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 20 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin | 30 Participants |
Secondary
Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet
Count of participants that have an open physician order for electronic glucose flowsheet end of the measurement period (Count of participants determined with a binary aggregation method; 1= Participant had an open physician order for electronic Glucose Flow Sheet at end of measurement period; 0= Participant did not have an open physician order for electronic Glucose Flow Sheet at end of measurement period)
Time frame: at 14 and 26 weeks after initial practice orientation
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| 1: Control | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 14 | 5 Participants |
| 1: Control | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 26 | 6 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 14 | 466 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 26 | 466 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 14 | 589 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 26 | 589 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 26 | 555 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 14 | 554 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 14 | 573 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet | Week 26 | 573 Participants |
Secondary
Count of Participants With Changes to Active Medication List
Count of Participants with Changes (Any; Addition; Removal) to list of active medications in EMR during measurement period. Active medication lists is comprised of prescription ordered medications for participants. Count of participants determined with a binary aggregation method: Any Change is defined as medications added or removed from active list ( 1= Participant had medications added to or removed from active medication list; 0= Participant did not have medication added to or removed from active medication list). Medications Added is defined as the addition of medications to active medication list ( 1= Participant had medications added to active medication list; 0= Participant did not have medications added to active medication list). Medications Removed is defined as the removal of medications to active medication list ( 1= Participant had medications removed from active medication list; 0= Participant did not have medications removed from active medication list).
Time frame: (1-14); (1-26) weeks after initial practice orientation
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| 1: Control | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-14 | 709 Participants |
| 1: Control | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-26 | 555 Participants |
| 1: Control | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-26 | 1087 Participants |
| 1: Control | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-14 | 742 Participants |
| 1: Control | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-26 | 1132 Participants |
| 1: Control | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-14 | 395 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-14 | 129 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-14 | 135 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-26 | 188 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-14 | 71 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-26 | 198 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-26 | 96 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-14 | 73 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-26 | 95 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-26 | 199 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-14 | 131 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-14 | 133 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-26 | 188 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-14 | 75 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-26 | 214 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-14 | 141 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-26 | 223 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-26 | 117 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-14 | 137 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-26 | 121 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Changes to Active Medication List | Medication Removed - Weeks 1-14 | 77 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-14 | 140 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Changes to Active Medication List | Any Change - Weeks 1-26 | 251 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-14 | 137 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Changes to Active Medication List | Medication Added - Weeks 1-26 | 247 Participants |
Secondary
Count of Participants With Improvement of HbA1c Test Results
Count of participants with improved HbA1c test result values in most recent Electronic Medical Record (EMR) during measurement period as compared to HbA1c test value at baseline. (Count of participants determined with a binary aggregation method; 1= Participant Improved, most recent A1c test value less than baseline A1c test value; 0= Participant did not Improve; most recent A1c test value greater than or equal to baseline A1c test value) Improvement of HbA1c test results is defined as a reduction of the most recent and available HbA1c test value (a lower percent A1c) in the EMR at appropriate time period relative to the baseline. Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. Higher percent A1c levels are associated with poor blood sugar control and increased risk of of diabetes-related complications.
Time frame: 14; 26 weeks after initial practice orientation
Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframes.~Participants with no test results or with missing values in their EMR at appropriate timepoints were not included in analysis.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| 1: Control | Count of Participants With Improvement of HbA1c Test Results | At Week 14 | 666 Participants |
| 1: Control | Count of Participants With Improvement of HbA1c Test Results | At Week 26 | 961 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Improvement of HbA1c Test Results | At Week 14 | 155 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Improvement of HbA1c Test Results | At Week 26 | 195 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Improvement of HbA1c Test Results | At Week 14 | 158 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Improvement of HbA1c Test Results | At Week 26 | 229 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Improvement of HbA1c Test Results | At Week 26 | 204 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Improvement of HbA1c Test Results | At Week 14 | 160 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Improvement of HbA1c Test Results | At Week 14 | 147 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Improvement of HbA1c Test Results | At Week 26 | 215 Participants |
Secondary
Count of Participants With Percent A1c Below Benchmark of 7
Count of participants with most recent HbA1c test value (percent A1c) in Electronic Medical Records below target benchmark of 7 at appropriate time point (Count of participants determined with a binary aggregation method; 1= Participant HbA1c test value less than 7; 0= Participant Hb1Ac test value greater than or equal to 7). Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. A percent A1c level less than 7 is a common treatment target and is associated with with a lower risk of diabetes-related complications.
Time frame: 14; 26 weeks after initial practice orientation
Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe.~Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| 1: Control | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 14 | 1846 Participants |
| 1: Control | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 26 | 1799 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 14 | 388 Participants |
| 2a: Practice Orientation- No Reminder | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 26 | 368 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 14 | 453 Participants |
| 2b: Practice Orientation- Standard Reminder | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 26 | 453 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 26 | 421 Participants |
| 2c: Practice Orientation- Gift Card Reminder | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 14 | 442 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 14 | 458 Participants |
| 2d: Practice Orientation- Physician Reminder | Count of Participants With Percent A1c Below Benchmark of 7 | At Week 26 | 443 Participants |
Secondary
Flowsheet Entry Values (Descriptive)
Value of blood glucose entered into flowsheet (descriptive analysis). No systematic outcomes recorded to report.
Time frame: 2; 4; 6; 8; 10; 12; 14; 18; 22; 26 weeks after initial orientation meeting
Population: Data not collected.
Secondary
Number of Days Participant Used Flowsheet, Intensive
The total number of days of participant use of the electronic glucose flowsheet during the measurement period. A day of Participant use of electronic glucose flowsheet is defined here as as day (24 hours) in which the participant performed an entry into an electronic glucose flowsheet.
Time frame: (1-14); (15-26) weeks after initial practice orientation
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1: Control | Number of Days Participant Used Flowsheet, Intensive | Weeks 1-14 | 0.011 days | Standard Deviation 0.439 |
| 1: Control | Number of Days Participant Used Flowsheet, Intensive | Weeks 15-26 | 0.009 days | Standard Deviation 0.386 |
| 2a: Practice Orientation- No Reminder | Number of Days Participant Used Flowsheet, Intensive | Weeks 1-14 | 0.501 days | Standard Deviation 4.281 |
| 2a: Practice Orientation- No Reminder | Number of Days Participant Used Flowsheet, Intensive | Weeks 15-26 | 0.353 days | Standard Deviation 3.986 |
| 2b: Practice Orientation- Standard Reminder | Number of Days Participant Used Flowsheet, Intensive | Weeks 1-14 | 0.350 days | Standard Deviation 2.693 |
| 2b: Practice Orientation- Standard Reminder | Number of Days Participant Used Flowsheet, Intensive | Weeks 15-26 | 0.213 days | Standard Deviation 2.865 |
| 2c: Practice Orientation- Gift Card Reminder | Number of Days Participant Used Flowsheet, Intensive | Weeks 15-26 | 0.406 days | Standard Deviation 4.338 |
| 2c: Practice Orientation- Gift Card Reminder | Number of Days Participant Used Flowsheet, Intensive | Weeks 1-14 | 0.663 days | Standard Deviation 5.031 |
| 2d: Practice Orientation- Physician Reminder | Number of Days Participant Used Flowsheet, Intensive | Weeks 1-14 | 0.691 days | Standard Deviation 4.683 |
| 2d: Practice Orientation- Physician Reminder | Number of Days Participant Used Flowsheet, Intensive | Weeks 15-26 | 0.502 days | Standard Deviation 4.83 |
Secondary
Number of Days Since Last HbA1c Test
The total number of days that elapsed since participant last had and HbA1c test. The number of days was measured by the number of days that passed from the date of the most recent HbA1c test in the Electronic Medical Record and the date of the data extraction at the specified time point.
Time frame: 14; 26 weeks after initial practice orientation
Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe.~Participants with no test results in their EMR at appropriate timepoint were not included in analysis
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1: Control | Number of Days Since Last HbA1c Test | Week 14 | 196.369 days | Standard Deviation 201.15 |
| 1: Control | Number of Days Since Last HbA1c Test | Week 26 | 196.434 days | Standard Deviation 207.394 |
| 2a: Practice Orientation- No Reminder | Number of Days Since Last HbA1c Test | Week 14 | 196.828 days | Standard Deviation 205.93 |
| 2a: Practice Orientation- No Reminder | Number of Days Since Last HbA1c Test | Week 26 | 208.781 days | Standard Deviation 215.284 |
| 2b: Practice Orientation- Standard Reminder | Number of Days Since Last HbA1c Test | Week 14 | 205.607 days | Standard Deviation 213.98 |
| 2b: Practice Orientation- Standard Reminder | Number of Days Since Last HbA1c Test | Week 26 | 216.949 days | Standard Deviation 220.655 |
| 2c: Practice Orientation- Gift Card Reminder | Number of Days Since Last HbA1c Test | Week 26 | 202.957 days | Standard Deviation 206.877 |
| 2c: Practice Orientation- Gift Card Reminder | Number of Days Since Last HbA1c Test | Week 14 | 192.341 days | Standard Deviation 192.651 |
| 2d: Practice Orientation- Physician Reminder | Number of Days Since Last HbA1c Test | Week 14 | 210.748 days | Standard Deviation 216.562 |
| 2d: Practice Orientation- Physician Reminder | Number of Days Since Last HbA1c Test | Week 26 | 216.812 days | Standard Deviation 229.55 |
Secondary
Participant A1c Test Results (as Percent A1c) at 14 Weeks
Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. The most recent and available HbA1c test value (percent A1c) in electronic medical records at appropriate time period was used
Time frame: 14 weeks after initial practice orientation
Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe.~Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 1: Control | Participant A1c Test Results (as Percent A1c) at 14 Weeks | 7.196 Percent A1c | Standard Deviation 1.601 |
| 2a: Practice Orientation- No Reminder | Participant A1c Test Results (as Percent A1c) at 14 Weeks | 7.276 Percent A1c | Standard Deviation 2.823 |
| 2b: Practice Orientation- Standard Reminder | Participant A1c Test Results (as Percent A1c) at 14 Weeks | 7.123 Percent A1c | Standard Deviation 1.465 |
| 2c: Practice Orientation- Gift Card Reminder | Participant A1c Test Results (as Percent A1c) at 14 Weeks | 7.183 Percent A1c | Standard Deviation 1.593 |
| 2d: Practice Orientation- Physician Reminder | Participant A1c Test Results (as Percent A1c) at 14 Weeks | 7.197 Percent A1c | Standard Deviation 1.767 |
Secondary
Prescription Orders
Number of prescription ordered medications for participant during measurement period (Total all; Total new/non-refill; Total diabetes related)
Time frame: (1-14); (1-26) weeks after initial practice orientation
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1: Control | Prescription Orders | Number of Non-Refill Orders - Weeks 1-14 | 5.111 number of orders | Standard Deviation 19.825 |
| 1: Control | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-26 | 1.28 number of orders | Standard Deviation 3.592 |
| 1: Control | Prescription Orders | Number of Non-Refill Orders - Weeks 1-26 | 9.296 number of orders | Standard Deviation 32.904 |
| 1: Control | Prescription Orders | Number of Total Prescription Orders - Weeks 1-14 | 5.111 number of orders | Standard Deviation 19.825 |
| 1: Control | Prescription Orders | Number of Total Prescription Orders - Weeks 1-26 | 9.296 number of orders | Standard Deviation 32.904 |
| 1: Control | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-14 | 0.678 number of orders | Standard Deviation 2.218 |
| 2a: Practice Orientation- No Reminder | Prescription Orders | Number of Non-Refill Orders - Weeks 1-26 | 10.544 number of orders | Standard Deviation 33.799 |
| 2a: Practice Orientation- No Reminder | Prescription Orders | Number of Total Prescription Orders - Weeks 1-26 | 10.554 number of orders | Standard Deviation 33.799 |
| 2a: Practice Orientation- No Reminder | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-26 | 1.318 number of orders | Standard Deviation 2.938 |
| 2a: Practice Orientation- No Reminder | Prescription Orders | Number of Total Prescription Orders - Weeks 1-14 | 5.912 number of orders | Standard Deviation 19.041 |
| 2a: Practice Orientation- No Reminder | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-14 | 0.718 number of orders | Standard Deviation 1.686 |
| 2a: Practice Orientation- No Reminder | Prescription Orders | Number of Non-Refill Orders - Weeks 1-14 | 5.192 number of orders | Standard Deviation 19.041 |
| 2b: Practice Orientation- Standard Reminder | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-14 | 0.591 number of orders | Standard Deviation 1.605 |
| 2b: Practice Orientation- Standard Reminder | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-26 | 1.036 number of orders | Standard Deviation 2.311 |
| 2b: Practice Orientation- Standard Reminder | Prescription Orders | Number of Total Prescription Orders - Weeks 1-26 | 8.050 number of orders | Standard Deviation 22.783 |
| 2b: Practice Orientation- Standard Reminder | Prescription Orders | Number of Non-Refill Orders - Weeks 1-14 | 4.488 number of orders | Standard Deviation 13.612 |
| 2b: Practice Orientation- Standard Reminder | Prescription Orders | Number of Non-Refill Orders - Weeks 1-26 | 8.050 number of orders | Standard Deviation 22.783 |
| 2b: Practice Orientation- Standard Reminder | Prescription Orders | Number of Total Prescription Orders - Weeks 1-14 | 4.488 number of orders | Standard Deviation 13.612 |
| 2c: Practice Orientation- Gift Card Reminder | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-26 | 1.162 number of orders | Standard Deviation 2.756 |
| 2c: Practice Orientation- Gift Card Reminder | Prescription Orders | Number of Non-Refill Orders - Weeks 1-26 | 8.242 number of orders | Standard Deviation 31.365 |
| 2c: Practice Orientation- Gift Card Reminder | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-14 | 0.691 number of orders | Standard Deviation 1.749 |
| 2c: Practice Orientation- Gift Card Reminder | Prescription Orders | Number of Total Prescription Orders - Weeks 1-26 | 8.242 number of orders | Standard Deviation 31.365 |
| 2c: Practice Orientation- Gift Card Reminder | Prescription Orders | Number of Non-Refill Orders - Weeks 1-14 | 4.733 number of orders | Standard Deviation 18.286 |
| 2c: Practice Orientation- Gift Card Reminder | Prescription Orders | Number of Total Prescription Orders - Weeks 1-14 | 4.733 number of orders | Standard Deviation 18.286 |
| 2d: Practice Orientation- Physician Reminder | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-26 | 1.063 number of orders | Standard Deviation 2.055 |
| 2d: Practice Orientation- Physician Reminder | Prescription Orders | Number of Diabetes Related Prescription Orders - Weeks 1-14 | 0.574 number of orders | Standard Deviation 1.335 |
| 2d: Practice Orientation- Physician Reminder | Prescription Orders | Number of Total Prescription Orders - Weeks 1-14 | 4.259 number of orders | Standard Deviation 12.866 |
| 2d: Practice Orientation- Physician Reminder | Prescription Orders | Number of Total Prescription Orders - Weeks 1-26 | 7.795 number of orders | Standard Deviation 20.211 |
| 2d: Practice Orientation- Physician Reminder | Prescription Orders | Number of Non-Refill Orders - Weeks 1-14 | 4.259 number of orders | Standard Deviation 12.866 |
| 2d: Practice Orientation- Physician Reminder | Prescription Orders | Number of Non-Refill Orders - Weeks 1-26 | 7.795 number of orders | Standard Deviation 20.211 |
Secondary
Total Number of Participant In-person Appointments
Total number of participant in-person appointments during the measurement period
Time frame: (1-14); (1-26) weeks after initial practice orientation
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1: Control | Total Number of Participant In-person Appointments | Weeks 1-14 | 1.275 number of appointments | Standard Deviation 3.476 |
| 1: Control | Total Number of Participant In-person Appointments | Weeks 1-26 | 2.326 number of appointments | Standard Deviation 5.322 |
| 2a: Practice Orientation- No Reminder | Total Number of Participant In-person Appointments | Weeks 1-14 | 1.314 number of appointments | Standard Deviation 3.914 |
| 2a: Practice Orientation- No Reminder | Total Number of Participant In-person Appointments | Weeks 1-26 | 2.358 number of appointments | Standard Deviation 5.4 |
| 2b: Practice Orientation- Standard Reminder | Total Number of Participant In-person Appointments | Weeks 1-14 | 1.251 number of appointments | Standard Deviation 3.58 |
| 2b: Practice Orientation- Standard Reminder | Total Number of Participant In-person Appointments | Weeks 1-26 | 2.153 number of appointments | Standard Deviation 4.775 |
| 2c: Practice Orientation- Gift Card Reminder | Total Number of Participant In-person Appointments | Weeks 1-26 | 2.083 number of appointments | Standard Deviation 4.652 |
| 2c: Practice Orientation- Gift Card Reminder | Total Number of Participant In-person Appointments | Weeks 1-14 | 1.109 number of appointments | Standard Deviation 2.782 |
| 2d: Practice Orientation- Physician Reminder | Total Number of Participant In-person Appointments | Weeks 1-14 | 1.191 number of appointments | Standard Deviation 2.991 |
| 2d: Practice Orientation- Physician Reminder | Total Number of Participant In-person Appointments | Weeks 1-26 | 2.188 number of appointments | Standard Deviation 4.452 |
Secondary
Total Number of Participant Phone Appointments
Total number of participant phone appointments during the measurement period
Time frame: (1-14); (1-26) weeks after initial practice orientation
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1: Control | Total Number of Participant Phone Appointments | Weeks 1-26 | 1.442 number of phone appointments | Standard Deviation 2.547 |
| 1: Control | Total Number of Participant Phone Appointments | Weeks 1-14 | 0.792 number of phone appointments | Standard Deviation 1.651 |
| 2a: Practice Orientation- No Reminder | Total Number of Participant Phone Appointments | Weeks 1-14 | 0.827 number of phone appointments | Standard Deviation 1.64 |
| 2a: Practice Orientation- No Reminder | Total Number of Participant Phone Appointments | Weeks 1-26 | 1.457 number of phone appointments | Standard Deviation 2.417 |
| 2b: Practice Orientation- Standard Reminder | Total Number of Participant Phone Appointments | Weeks 1-14 | 0.789 number of phone appointments | Standard Deviation 1.613 |
| 2b: Practice Orientation- Standard Reminder | Total Number of Participant Phone Appointments | Weeks 1-26 | 1.398 number of phone appointments | Standard Deviation 2.506 |
| 2c: Practice Orientation- Gift Card Reminder | Total Number of Participant Phone Appointments | Weeks 1-14 | 0.849 number of phone appointments | Standard Deviation 1.654 |
| 2c: Practice Orientation- Gift Card Reminder | Total Number of Participant Phone Appointments | Weeks 1-26 | 1.485 number of phone appointments | Standard Deviation 2.525 |
| 2d: Practice Orientation- Physician Reminder | Total Number of Participant Phone Appointments | Weeks 1-14 | 0.765 number of phone appointments | Standard Deviation 1.432 |
| 2d: Practice Orientation- Physician Reminder | Total Number of Participant Phone Appointments | Weeks 1-26 | 1.434 number of phone appointments | Standard Deviation 2.42 |
Secondary
Total Secure Messages Sent by Participant
Total number of messages sent by participant via MyChart Electronic medical records system during the measurement period
Time frame: (1-14); (15-26) weeks after initial practice orientation
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 1: Control | Total Secure Messages Sent by Participant | Weeks 1-14 | 1.385 number of messages | Standard Deviation 3.016 |
| 1: Control | Total Secure Messages Sent by Participant | Weeks 15-26 | 1.128 number of messages | Standard Deviation 2.65 |
| 2a: Practice Orientation- No Reminder | Total Secure Messages Sent by Participant | Weeks 1-14 | 1.407 number of messages | Standard Deviation 2.872 |
| 2a: Practice Orientation- No Reminder | Total Secure Messages Sent by Participant | Weeks 15-26 | 1.226 number of messages | Standard Deviation 2.803 |
| 2b: Practice Orientation- Standard Reminder | Total Secure Messages Sent by Participant | Weeks 1-14 | 1.528 number of messages | Standard Deviation 3.272 |
| 2b: Practice Orientation- Standard Reminder | Total Secure Messages Sent by Participant | Weeks 15-26 | 1.077 number of messages | Standard Deviation 2.496 |
| 2c: Practice Orientation- Gift Card Reminder | Total Secure Messages Sent by Participant | Weeks 15-26 | 1.037 number of messages | Standard Deviation 2.338 |
| 2c: Practice Orientation- Gift Card Reminder | Total Secure Messages Sent by Participant | Weeks 1-14 | 1.434 number of messages | Standard Deviation 2.638 |
| 2d: Practice Orientation- Physician Reminder | Total Secure Messages Sent by Participant | Weeks 1-14 | 1.571 number of messages | Standard Deviation 3.282 |
| 2d: Practice Orientation- Physician Reminder | Total Secure Messages Sent by Participant | Weeks 15-26 | 1.135 number of messages | Standard Deviation 2.597 |
Secondary
Total Secure Messages Sent by Patient to Primary Care Provider
Total number of MyChart messages sent by patient to the Primary Care Provider (PCP) during the measurement period. Not reported separately from Total number of messages sent by patient, so outcomes not reported here.
Time frame: (1-14); (15-26) weeks after initial practice orientation
Population: Data not collected.
Secondary
Total Secure Messages Sent by PCP to Patient
Total number of MyChart messages sent by PCP to the patient during the measurement period
Time frame: (1-14); (15-26) weeks after initial practice orientation
Population: Data not collected.