Is Physician Engagement with Web-based CME Associated with Patients' Baseline Hemoglobin A1c Levels? The Rural Diabetes Online Care Study

Overview

Journal Acad Med

Specialty Medical Education

Date 2010 Aug 26

PMID 20736679

Citations 16

Authors

Katie Crenshaw

William Curry

Amanda H Salanitro

Monika M Safford

Thomas K Houston

Jeroan J Allison

Carlos A Estrada

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the association between physician participants' levels of engagement in a Web-based educational intervention and their patients' baseline diabetes measures.

Method: The authors conducted a randomized trial of online CME activities designed to improve diabetes care provided by family, general, and internal medicine physicians in rural areas of 11 southeastern states between September 2006 and July 2008. Using incidence rate ratios derived from negative binomial models, the relationship between physicians' engagement with the study Web site and baseline proportion of their patients having controlled diabetes (hemoglobin A1c < or = 7%) was explored.

Results: One hundred thirty-three participants (intervention = 64; control = 69) provided information for 1,637 patients with diabetes. In the intervention group, physicians in practices in the worst quartiles of A1c control were least engaged with the study Web site in nearly all dimensions. Total number of pages viewed decreased as quartile of A1c control worsened (137, 73, 68, 57; P = .007); similarly, for a given 10% increase in proportion of patients with controlled A1c, participants viewed 1.13 times more pages (95% CI: 1.02-1.26, P = .02). In the control group, engagement was neither correlated with A1c control nor different across quartiles of A1c control.

Conclusions: Engagement in Web-based interventions is measurable and has important implications for research and education. Because physicians of patients with the greatest need for improvement in A1c control may not use online educational resources as intensely as others, other strategies may be necessary to engage these physicians in professional development activities.

Citing Articles

The design and rationale of a multicenter real-world trial: The Southeastern Collaboration to Improve Blood Pressure Control in the US Black Belt - Addressing the Triple Threat.

Safford M, Cummings D, Halladay J, Shikany J, Richman J, Oparil S Contemp Clin Trials. 2023; 129:107183.

PMID: 37061162 PMC: 10225352. DOI: 10.1016/j.cct.2023.107183.

Perceptions and behaviors of learner engagement with virtual educational platforms.

Dickinson K, Caldwell K, Graviss E, Nguyen D, Awad M, Olasky J Am J Surg. 2022; 224(1 Pt B):371-374.

PMID: 35184816 PMC: 8853863. DOI: 10.1016/j.amjsurg.2022.02.043.

Patterns for Patient Engagement with the Hypertension Management and Effects of Electronic Health Care Provider Follow-up on These Patterns: Cluster Analysis.

Wu D, An J, Yu P, Lin H, Ma L, Duan H J Med Internet Res. 2021; 23(9):e25630.

PMID: 34581680 PMC: 8512186. DOI: 10.2196/25630.

The relationship between learner engagement and teaching effectiveness: a novel assessment of student engagement in continuing medical education.

Stephenson C, Bonnes S, Sawatsky A, Richards L, Schleck C, Mandrekar J BMC Med Educ. 2020; 20(1):403.

PMID: 33148231 PMC: 7640708. DOI: 10.1186/s12909-020-02331-x.

Knowledge of physicians regarding the management of Type two Diabetes in a primary care setting: the impact of online continuous medical education.

Emami Z, Kouhkan A, Khajavi A, Khamseh M BMC Med Educ. 2020; 20(1):374.

PMID: 33081765 PMC: 7574317. DOI: 10.1186/s12909-020-02212-3.

References

Casebeer L, Allison J, Spettell C . Designing tailored Web-based instruction to improve practicing physicians' chlamydial screening rates. Acad Med. 2002; 77(9):929. DOI: 10.1097/00001888-200209000-00032. View

Allison J, Kiefe C, Wall T, Casebeer L, Ray M, Spettell C . Multicomponent Internet continuing medical education to promote chlamydia screening. Am J Prev Med. 2005; 28(3):285-90. DOI: 10.1016/j.amepre.2004.12.013. View

Hutchinson M, Holtman M . Analysis of count data using poisson regression. Res Nurs Health. 2005; 28(5):408-18. DOI: 10.1002/nur.20093. View

Casebeer L, Engler S, Bennett N, Irvine M, Sulkes D, DesLauriers M . A controlled trial of the effectiveness of internet continuing medical education. BMC Med. 2008; 6:37. PMC: 2612689. DOI: 10.1186/1741-7015-6-37. View

Bennett N, Casebeer L, Kristofco R, Strasser S . Physicians' Internet information-seeking behaviors. J Contin Educ Health Prof. 2004; 24(1):31-8. DOI: 10.1002/chp.1340240106. View

Fordis M, King J, Ballantyne C, Jones P, Schneider K, Spann S . Comparison of the instructional efficacy of Internet-based CME with live interactive CME workshops: a randomized controlled trial. JAMA. 2005; 294(9):1043-51. DOI: 10.1001/jama.294.9.1043. View

Curran V, Fleet L . A review of evaluation outcomes of web-based continuing medical education. Med Educ. 2005; 39(6):561-7. DOI: 10.1111/j.1365-2929.2005.02173.x. View

Wantland D, Portillo C, Holzemer W, Slaughter R, McGhee E . The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes. J Med Internet Res. 2005; 6(4):e40. PMC: 1550624. DOI: 10.2196/jmir.6.4.e40. View

Safford M, Shewchuk R, Qu H, Williams J, Estrada C, Ovalle F . Reasons for not intensifying medications: differentiating "clinical inertia" from appropriate care. J Gen Intern Med. 2007; 22(12):1648-55. PMC: 2219839. DOI: 10.1007/s11606-007-0433-8. View

10.

Davis D, Mazmanian P, Fordis M, Harrison R, Thorpe K, Perrier L . Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006; 296(9):1094-102. DOI: 10.1001/jama.296.9.1094. View

11.

. Standards of medical care in diabetes--2008. Diabetes Care. 2008; 31 Suppl 1:S12-54. DOI: 10.2337/dc08-S012. View

12.

Chobanian A, Bakris G, Black H, Cushman W, Green L, Izzo Jr J . The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289(19):2560-72. DOI: 10.1001/jama.289.19.2560. View

13.

Matzie K, Kerfoot B, Hafler J, Breen E . Spaced education improves the feedback that surgical residents give to medical students: a randomized trial. Am J Surg. 2008; 197(2):252-7. DOI: 10.1016/j.amjsurg.2008.01.025. View

14.

Houston T, Wall T, Allison J, Palonen K, Willett L, Keife C . Implementing achievable benchmarks in preventive health: a controlled trial in residency education. Acad Med. 2006; 81(7):608-16. DOI: 10.1097/01.ACM.0000232410.97399.8f. View

15.

Peabody J, Luck J, Glassman P, Jain S, Hansen J, Spell M . Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med. 2004; 141(10):771-80. DOI: 10.7326/0003-4819-141-10-200411160-00008. View

16.

Danaher B, Boles S, Akers L, Gordon J, Severson H . Defining participant exposure measures in Web-based health behavior change programs. J Med Internet Res. 2006; 8(3):e15. PMC: 1761946. DOI: 10.2196/jmir.8.3.e15. View

17.

Kiefe C, Allison J, Williams O, Person S, Weaver M, Weissman N . Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial. JAMA. 2001; 285(22):2871-9. DOI: 10.1001/jama.285.22.2871. View

18.

Hayward R, Hofer T, Vijan S . Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Ann Intern Med. 2006; 145(7):520-30. DOI: 10.7326/0003-4819-145-7-200610030-00010. View

19.

Podichetty V, Booher J, Whitfield M, Biscup R . Assessment of internet use and effects among healthcare professionals: a cross sectional survey. Postgrad Med J. 2006; 82(966):274-9. PMC: 2579634. DOI: 10.1136/pgmj.2005.040675. View

20.

Houston T, Funkhouser E, Allison J, Levine D, Williams O, Kiefe C . Multiple measures of provider participation in Internet delivered interventions. Stud Health Technol Inform. 2007; 129(Pt 2):1401-5. View