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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3029 — A Group Randomized Trial of an Internet-Delivered Intervention Improved Lipid and Diabetes Control in Veterans with Myocardial Infarction: VA MI-Plus

Funkhouser EM (Birmingham REAP), Houston TK (Bedford COE), Levine DA (Ann Arbor COE), Richman J (Birmingham REAP), Johnson-Roe NK (Birmingham REAP), Kiefe CI (University of Massachusetts)

Objectives:
Often, quality improvement interventions are short-term with outcome measures limited to assessment of physician performance. We assessed whether a group-randomized trial of a 2-year Internet-delivered intervention improved lipid and diabetes control in veterans with MI.

Methods:
We recruited 168 CBOCs and 401 providers representing 16,314 patients. Intervention providers received a multi-modal Internet-delivered intervention launched in 11/2004 and closed in 01/2007. Outcomes consisted of 3 aspects of post-MI care: monitoring, treating, and changing of LDL and HbA1c levels. All outcome data was retrieved from Austin datasets. We identified all veterans with a VAMC discharge diagnosis of 410.xx or 412.xx between 2002-2008 who were treated at study CBOCs. We compared monitoring, treatment, and change in LDL and hemoglobin A1c across the pre- (2002-11/2004) and post-intervention (02/2007-2008) periods and adjusted for patient clustering.

Results:
Participating providers by randomization arm: 205 intervention and 196 control. Among intervention providers who logged on, the median time on was 6.3 months; 23.3% stayed involved over a 12-month period. Monitoring and treating of LDL and HbA1c improved from pre- to post-intervention periods, generally more for intervention than control, but not significantly so. LDL levels decreased more in the intervention than control groups (18 vs. 14 mg/dl, P = 0.007). Among adults with diabetes, HbA1c levels decreased (-0.13%) in intervention but not in control (0.14%), P = 0.01.

Implications:
This intervention was effective in improving lipid and diabetes control among veterans with MI.

Impacts:
Internet-delivered educational interventions can lead to improvements in physiologic measures of cardiovascular risk factors.


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