Computerized decision support, task delegation and feedback on performance in type 2 diabetes care : the diabetes care protocol

The increasing number of type 2 diabetes patient and the strict targets for glycemic and cardiovascular control demand a good practice organisation and task delegation. The Diabetes Care Protocol (DCP) may improve diabetes management. It consists of a diabetes consultation hour run by a practice nurse, a computerized decision support system (CDSS) that contains a diagnostic and treatment algorithm based on the Dutch type 2 diabetes guidelines and provides patient-specific treatment advice, a recall system and feedback on performance. This thesis evaluates the effectiveness of the DCP. A before-after trial in 113 DCP practices showed improvements in the number of patients reaching treatment targets for HbA1c, blood pressure and cholesterol. This finding was then confirmed by a 1-year cluster randomized trial in 55 primary care practices. Mean changes in cardiovascular risk factors were calculated by generalized linear models. HbA1c difference was not significant, blood pressure, total cholesterol and LDL-cholesterol were. The 10-year UK prospective diabetes study coronary heart disease risk improved 1.4% (