Diabetes registries in patient-centered medical homes

BACKGROUND: Little is known about the effectiveness of a patient registry, an attribute within the patient-centered medical home (PCMH) model, as it relates to diabetes health outcomes. The purpose of this retrospective study was to compare hemoglobin A1c (HbA1c) values for patients (n = 713) from clinics with an established diabetes registry (n = 7) to patients (n = 325) at clinics without a diabetes registry (n = 15), and determine whether HbA1c levels improve significantly more over time at registry clinics compared to nonregistry clinics.

METHODS: Up to 3 most recent sequential HbA1c values, along with demographic variables of age, body mass index (BMI), gender, race, insurance type, marital status, and whether or not the patient lived in the local area around the medical center were extracted from the electronic medical record used throughout the primary health care system. Presence of comorbid conditions of lipid metabolism and hypertension disorders were also collected. Analysis of variance and propensity-score-matched 2-sample analyses were used to examine the association between diabetes registry status HbA1c, controlling for demographic variables.

RESULTS: Analyses indicated no evidence that patients in clinics with established diabetes registries had improved HbA1c levels significantly more than patients in clinics without diabetes registries.

DISCUSSION: Patients in clinics with diabetes registry did not have greater overall improvement in HbA1c values than patients in nondiabetes registry clinics. However, patients at all clinics had significantly reduced HbA1c values over time. More research is needed to determine if registries are effective PCMH tools to reduce diabetes morbidity and mortality.