Table 1 Results for CCDSS trials of chronic disease management

Holbrook, 2009[2, 3]

Web-based tracking of diabetes monitoring in adults in primary care.

18/46/511*

Measurement of HbA_1c, BP, LDL-C, albuminuria, BMI, exercise, and smoking status; foot surveillance.

Levels of BP, LDL-C, HbA_1c, and albuminuria; BMI, exercise rate, absence of foot neuropathy and smoking; quality of life.

Maclean, 2009[11, 12]

Reminders for the management of diabetes in primary care.

64*/132/7,412

Test completion within guideline-specified times (HbA_1c, lipids, serum creatinine, and urine microalbumin).

Mean HbA_1c level; patients with HbA_1c <7%.

Christian, 2008[13]

Patient feedback and physician recommendations for management obesity and type 2 diabetes in primary care.

2/19/273*

...

Weight change; patients with ≥5% weight loss.

Cleveringa2008 [14–17]

Recommendations for management of type 2 diabetes in primary care.

55*/.../3,391

Diabetes treatment satisfaction score.

Mean HbA_1c.

Peterson, 2008[18]

Visit reminders and patient-specific physician alerts and progress reports for organization of primary care in patients with type 2 diabetes.

24*/238/7,101

Completion of foot and eye exams, BP monitoring, and renal, HbA_1c, and LDL-C tests.

Patients with target composite clinical outcome (SBP <130 mm Hg, HbA_1c <7%, and LDL-C <100 mg/dL).

Quinn, 2008[19]

Cell phone-based type 2 diabetes management, with real-time coaching for patients and remote monitoring of blood glucose for practitioners in primary care.

3/26/30*

Medications intensified and medication errors identified.

Mean HbA_1c.

Augstein, 2007[20]

Recommendations for management of diabetes in outpatients.

5/5/49*

...

Change in HbA_1c and glucose levels.

Filippi, 2003[21]

Reminders for prescribing of anti-platelet medications to diabetic primary care patients.

.../300*/15,343

Patients with antiplatelet drug prescriptions.

...

Meigs, 2003[22]

Feedback for management of type 2 diabetes in a hospital-based internal medicine clinic.

1/66*/598

Use of HbA_1c and LDL-C tests; BP measurement; eye and foot exams.

Patients with HbA_1c <7%; change in HbA_1c levels.

Lobach, 1997[23]

Recommendations for screening, monitoring, and management of diabetes in primary care.

1/58*/497

Compliance with diabetes management recommendations (foot, ophthalmologic, and complete physical exams; chronic glycaemia monitoring; urine protein and cholesterol levels; and influenza and pneumococcal vaccinations).

...

Nilasena, 1995[24]

Reminders for preventive care activities in diabetic outpatients.

2/35*/164

Compliance with preventive care guidelines.

...

Mazzuca, 1990[25]

Reminders generated from the medical record system and placed in patients' clinic records for the management of non-insulin dependent diabetes mellitus in outpatients.

4*/114/279

Adherence to five recommendations for care of non-insulin dependent diabetes (HbA_1c and fasting blood glucose laboratory orders, start home monitoring of blood glucose, diet clinic referral, and start oral hypoglycaemic therapy).

...

...

Thomas, 1983[26]

Recommendations for test ordering, prescribing, and early diagnosis for ambulatory patients in primary care.

1/.../185*

Diabetic clinic visits.

Emergency department visits; hospitalizations and time hospitalized; BP and glucose levels; obesity.

Derose, 2005[27]

Recommendations for prescription of ACE-Is, ARBs, and statins in outpatients with diabetes or atherosclerosis.

.../1089/8,557*

Appropriate prescription of ACE-Is, ARBs, or statins within two weeks after patient visit.

...

Sequist, 2005[28]

Reminders, based on evidence-based guidelines, for management of diabetes and coronary artery disease in primary care.

20*/194/6,243

Receipt of recommended care for diabetes (cholesterol, HbA_1c, and dilated eye exams, and use of ACE-Is or statins) or coronary artery disease (cholesterol exam and use of aspirin, beta-blockers, and statins).

...

Martin, 2004[29]

Alerts for management of elderly patients in a health maintenance organization setting.

...*/104/8,504

Disenrollment from Health Management Organization plan; patient satisfaction with health plan.

General health (SF-36 score); inpatient and skilled nursing facility admissions.

Demakis, 2000[30]

Reminders for screening, monitoring, and counselling in accordance with predefined standards of care in ambulatory care.

12*/275/12,989

Compliance with 13 standards of care for coronary artery disease, hypertension, diabetes, smoking cessation, vaccination, warfarin treatment monitoring, atrial fibrillation, myocardial infarction, and gastrointestinal bleeding.

...

Hetlevik, 1999[31–33]

Physician-initiated guideline-based guidance for diagnosis and management of hypertension, diabetes mellitus, and hypercholesterolemia in primary care.

56*/56/3,273

Hypertension and diabetic patients without recorded data for BP, serum cholesterol, BMI, smoking status, CHD risk score, and CV inheritance; diabetic patients without recorded data for HbA_1c levels.

SBP and DBP levels; serum cholesterol levels; BMI; change in smoking status; change in CHD risk score and proportion of patients with CV inheritance; and, for diabetic patients, HbA_1c levels.

Bosworth, 2009[34]

Recommendations for management of hypertension in primary care.

1*/32/588

...

Change in BP control.

Hicks, 2008[35]

Reminders for management of hypertension in adults in primary care.

14*/.../2,027

Visit-specific adherence to guideline medication prescribing.

Patients with controlled BP.

Borbolla, 2007[36]

Recommendations for monitoring of BP in outpatients and primary care patients with chronic disease.

.../182*/2,315

BP measurement for appropriate patients.

Mean SBP and DBP.

Mitchell, 2004[37]

Feedback for identification, treatment, and control of hypertension in elderly patients in primary care.

52*/.../30,345

Patients without BP measurements.

SBP levels; patients with controlled hypertension.

Murray, 2004[38]

Treatment recommendations for management of hypertension in primary care.

4/...*/712

Compliance with antihypertensive drug recommendations; patient satisfaction with physicians and pharmacists.

Quality of life measured using SF-36 and a locally validated generic quality of life indicator.

Montgomery, 2000[39]

Computer support system provided patient-specific five-year CV risk for management of hypertension in primary care.

27*/85/614

Number of patients prescribed CV drugs.

Five-year CV risk; SBP; DBP.

Rossi, 1997[40]

Reminders to modify drug therapy in hypertensive outpatients receiving calcium channel blockers.

1/71/719*

Prescription changes from a calcium channel blocker to another antihypertensive agent.

McAlister, 1986[41]

Feedback to physicians for management of hypertension in primary care.

50/50*/2,231

Length of follow up; number of office visits; patients treated for hypertension.

Patients with DBP ≤90 mmHg; duration of DBP ≤90 mmHg; change in DBP.

Rogers, 1984[42–44]

Detection of deficiencies in care and recommendations for the management of hypertension, obesity and renal disease in outpatients.

1/.../484*

Patients with hypertension given renal function, potassium, or fundoscopic exams, or intravenous pyelograms; number of diets given to or reviewed with obesity patients; patients with renal disease given renal function exams, urine analysis, or urine culture; perceived quality of communication.

Perceived health status.

Coe, 1977[45]

Recommendations for management of hypertension medication in patients attending hypertension clinics.

2/.../116*

...

Adequate BP control.

Fiks, 2009[46]

Alerts for influenza vaccination for children and adolescents with asthma in primary care.

20*/.../11,919

Captured opportunities for vaccination; up-to-date vaccination rates (adjusted analysis).

...

Poels, 2009[47]

Presentation of data to assist in the diagnosis and management of chronic airway diseases in primary care.

44*/.../868

Change in diagnoses.

...

Martens, 2007[48, 49]

Recommendations for appropriate use of antibiotics and management of asthma, COPD, and dyslipidemia.

23*/53/3,496

Appropriate prescribing or lack of prescribing of drugs.

...

Kattan, 2006[50]

Recommendations for management of drug therapy in severe asthma in paediatric outpatients.

.../435/937*

Time to appropriate medication step-up; % of scheduled visits within 2 months of medication step-up recommendation.

Symptom days every 2 weeks.

Kuilboer, 2006[51]

Recommendations for monitoring and treatment of asthma and COPD in primary care.

32*/40/156,772

Contact frequency; peak flow and FEV1 measurements; number of prescriptions for respiratory drugs.

...

Plaza, 2005[52]

Guideline-based recommendations to general practitioners and pneumologists for cost-effective management of asthma in primary care.

.../20*/198

Health resource use (spirometry, blood tests, total immunoglobulin E, skin allergy tests, thorax radiography, and oral glucocorticoid prescriptions); medical visits; home visits; visits to other physicians.

St. George Respiratory Questionnaire total score.

Tierney, 2005[53]

Recommendations for the management of asthma and COPD in adults in primary care.

4/266*/706

Adherence to management recommendations.

SF-36 subscale scores; McMaster Asthma Quality of Life Questionnaire scores; McMaster Chronic Respiratory Disease Questionnaire scores; emergency department visits; hospitalizations.

Eccles, 2002[54, 55]^b

Care recommendations for management of asthma and angina in adults in primary care.

62*/.../4,506

Adherence to guideline recommendations for angina (record BP, 12-lead and exercise electrocardiogram, Hb and lipid levels, blood glucose levels, thyroid function, and record or provide advice for exercise, weight, and smoking) and medications prescribed for angina; adherence to guideline recommendations for asthma (assessment of lung function, compliance, inhaler technique, and smoking status, and provision of asthma education, action plan, smoking cessation advice, or nicotine replacement therapy) and prescription of drugs for asthma.

Quality of life (SF-36 and EQ-5D questionnaires); disease-specific quality of life (Seattle angina questionnaire, Newcastle asthma symptoms questionnaire, and the asthma quality of life questionnaire); angina or asthma consultations.

McCowan2001[56]

Guideline-based recommendations for management of asthma in primary care.

...*/46/477

Practice initiated reviews; peak flow meters issued; self-management plans used; symptom assessments; prescriptions for oral corticosteroids and emergency nebulizations.

Acute asthma exacerbations; patient-initiated primary care consultations.

Bertoni, 2009[57, 58]

Recommendations for guideline-consistent screening and treatment of dyslipidemia in primary care.

59*/.../3,821

Change from baseline in number of patients with appropriate lipid management (based on LDL-C and risk strata).

...

Gilutz, 2009[59]

Reminders for monitoring and treatment of patients previously hospitalized with coronary artery disease and followed up in primary care.

112*/600/7,448

Appropriate initiation, up-titration, or continuation of statin therapy; rate of adequate lipoprotein monitoring.

Reduction in LDL-C.

Lester, 2006[60, 61]

Recommendations, based on evidence-based guidelines, for the management of patients at high risk for hyperlipidemia in primary care.

1/14/235*

Patients with changes in statin prescriptions at 1 month and 12 months.

Change in LDL-C.

Cobos, 2005[62]

Recommendations for hypercholesterolemia therapy, follow-up visit frequency, and laboratory test ordering for patients with hypercholesterolemia in primary care.

42*/.../2,221

Number of scheduled physician visits and patient assessments (lipids, aspartate or alanine aminotransferase, or creatine kinase); number of patients treated with lipid-lowering drugs.

Patients successfully managed according to CV risk level assessed by LDL-C levels or maintenance of CV risk level.

Goud, 2009[63, 64]

Recommendations for guideline-consistent care plans for outpatient cardiac rehabilitation.

35*/50/2,787

Compliance with guideline recommendations for exercise training, education therapy, relaxation therapy, and lifestyle change therapy.

...

Feldman, 2005[65, 66]

Recommendations for nurse-coordinated management of patients with heart failure receiving home care.

.../354*/628

Patient adherence to self-management indicators (taking and recognizing medications, salting food, and weighing behavior), home-care related visits, and outpatient doctor visits.

Kansas City Cardiomyopathy Questionnaire and EuroQoL EQ-5D scale scores; depression (Geriatric Depression Scale); service use (hospitalizations, inpatient nights, and emergency department visits).

Tierney, 2003[67]

Guideline-based recommendations for management of heart disease in primary care.

4*/115/706

Adherence with cardiac care recommendations.

Quality of life (SF-36 scale and chronic heart disease questionnaire).

Eccles, 2002[54, 55]^b

Care recommendations for management of asthma and angina in adults in primary care.

62*/.../4,506

Adherence to guideline recommendations for angina (record BP, 12-lead and exercise electrocardiogram, Hb and lipid levels, blood glucose levels, thyroid function, and record or provide advice for exercise, weight, and smoking) and medications prescribed for angina; adherence to guideline recommendations for asthma (assessment of lung function, compliance, inhaler technique, and smoking status, and provision of asthma education, action plan, smoking cessation advice, or nicotine replacement therapy) and prescription of drugs for asthma.

Quality of life (SF-36 and EQ-5D questionnaires); disease-specific quality of life (Seattle angina questionnaire, Newcastle asthma symptoms questionnaire, and the asthma quality of life questionnaire); angina or asthma consultations.

Lee, 2009[68, 69]

Recommendations for screening, diagnosis and obesity care planning in acute and primary care.

.../29*/1,874

Encounters with obesity-related diagnoses or missing obesity-related diagnoses, and obesity -related diagnoses not screened and entered in CCDSS.

...

Locatelli, 2009[70]

Recommendations for management of chronic kidney disease in nephrology units.

53*/.../599

Use of iron therapy or erythropoetic therapy; guideline-adherent treatment.

Achievement of hematological targets (Hb, serum ferritin, hypochromic red cell count); mean Hb level.

Javitt, 2008[71]

Patient-specific recommendations for detecting and correcting medical errors in a health maintenance organization setting.

1/1378/49,988*

Resolution rate for identified problems (add a drug, do a test, or stop a drug).

...

Verstappen 2007[72]

Management of methotrexate for early rheumatoid arthritis in adult outpatients.

6/.../299*

...

Patients in remission for ≥3 months in first two years.

Downs, 2006[73]

Prompts for the investigation and management of dementia in primary care.

35*/.../450

Detection of dementia; compliance with diagnostic guidelines.

...

Feldstein, 2006b[74]

Guideline-recommended osteoporosis care for 50-89 year old women in primary care who experience a fracture.

15/159/311*

Measurement of bone mineral density; use of osteoporosis medication.

Caloric expenditure; regular physical activity; calcium intake.

McDonald2005[75]

Recommendations to home care nurses for cancer pain assessment and guideline-based management.

1/336*/673

Nurse assessment practices (pain, medications, mood, and bowel movement); nurse instruction practices (medication and side effect management, pain management, contacting physicians, and education); cost-effectiveness for reductions in pain and hospitalizations.

Pain; quality of life (European Organization for Research and Treatment of Cancer questionnaire); symptom management; cost-effectiveness.

Dexter, 1998[76]

Reminders to discuss and complete advanced directives in outpatients.

4*/10/1,042

Rate of advance directive discussions; rate of form completion.

...

Rubenstein1995[77]

Computer-generated feedback designed to identify and suggest management for functional deficits in primary care.

1*/73/557

Clinical problems listed at visits; functional status interventions for patients with functional status problems; physician attitudes toward managing functional status.

Functional status (basic and intermediate activities of daily living, mental health, social activities, and work performance); specific impairments (physical, psychological, or social function).

Petrucci, 1991[78]

Recommendations for nurse management of urinary incontinence in elderly patients in nursing homes.

...*/50/27

Nurses' knowledge about urinary incontinence care.

Wet occurrences.

McDonald1984[79]

Reminders for management of outpatients, including cancer screening, vaccinations, and weight reduction counselling.

1*/130/12,467

Rate of clinician response to indications for care actions.

Hospitalizations; emergency room and clinic visits; and time averaged values for DBP/SBP; weight; serum glucose; serum Hb; serum potassium; blood urea nitrogen.