Trial Outcomes & Findings for Blood Glucose Monitoring in Electronic Health Records (NCT NCT03542487)

Results Overview

Count of participants that entered data to an electronic glucose flowsheet during the measurement period (Count of participants determined with a binary aggregation method; 1= Participant used Flow Sheet at least once during measurement period; 0= Participant did not use Flow Sheet during Measurement Period)

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

7052 participants

Primary outcome timeframe

(1-14) weeks after initial practice orientation

Results posted on

2024-09-19

Participant Flow

20 primary care practices were randomly assigned to treatment (10 practices, 3411 patients) and control (10 practices, 3641 patients). Participants at treated primary care practices whose providers placed flow sheet orders (2182 patients total) were assigned to 1 of 4 reminder message groups to encourage utilization of the flow sheets. Assignment to reminder groups was determined alphabetically by the first letter of participant's last name.

Unit of analysis: primary care practices

Participant milestones

Participant milestones
Measure	1: Control A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	Experimental Participants at treated primary care practices whose doctors placed flow sheet orders (2182 patients total) were assigned to 1 of 4 reminder message groups to encourage utilization of the flow sheets	2a: Participants in the Practice Orientation- No Reminder Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Participants in the Practice Orientation- Standard Reminder Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets	2c: Participants in the Practice Orientation- Gift Card Reminder Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	2d: Participants in the Practice Orientation- Physician Reminder Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).
Primary Care Practices Randomization STARTED	3641 10	3411 10	0 0	0 0	0 0	0 0
Primary Care Practices Randomization COMPLETED	3641 10	2182 10	0 0	0 0	0 0	0 0
Primary Care Practices Randomization NOT COMPLETED	0 0	1229 0	0 0	0 0	0 0	0 0
Participant Randomization STARTED	0 0	0 0	466 10	589 10	554 10	573 10
Participant Randomization COMPLETED	0 0	0 0	466 8	589 7	554 7	573 7
Participant Randomization NOT COMPLETED	0 0	0 0	0 2	0 3	0 3	0 3

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Participants in the Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Participants in the Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	2c: Participants in the Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	2d: Participants in the Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	Total n=7052 Participants Total of all reporting groups
Age, Continuous	58.863 years STANDARD_DEVIATION 14.0 • n=3641 Participants	58.885 years STANDARD_DEVIATION 14.9 • n=762 Participants	58.434 years STANDARD_DEVIATION 14.7 • n=895 Participants	58.756 years STANDARD_DEVIATION 14.5 • n=866 Participants	59.760 years STANDARD_DEVIATION 14.7 • n=888 Participants	58.910 years STANDARD_DEVIATION 14.3 • n=7052 Participants
Sex/Gender, Customized Male	1958 Participants n=3641 Participants	412 Participants n=762 Participants	494 Participants n=895 Participants	478 Participants n=866 Participants	496 Participants n=888 Participants	3838 Participants n=7052 Participants
Sex/Gender, Customized Female	1683 Participants n=3641 Participants	350 Participants n=762 Participants	401 Participants n=895 Participants	388 Participants n=866 Participants	392 Participants n=888 Participants	3214 Participants n=7052 Participants
Race/Ethnicity, Customized Ethnicity · Hispanic	253 Participants n=3641 Participants	27 Participants n=762 Participants	62 Participants n=895 Participants	50 Participants n=866 Participants	27 Participants n=888 Participants	419 Participants n=7052 Participants
Race/Ethnicity, Customized Ethnicity · White, Non-Hispanic	2908 Participants n=3641 Participants	622 Participants n=762 Participants	688 Participants n=895 Participants	704 Participants n=866 Participants	743 Participants n=888 Participants	5665 Participants n=7052 Participants
Race/Ethnicity, Customized Ethnicity · Other, Unknown, or Not reported	480 Participants n=3641 Participants	113 Participants n=762 Participants	145 Participants n=895 Participants	112 Participants n=866 Participants	118 Participants n=888 Participants	968 Participants n=7052 Participants
Percent A1c, Baseline	7.219 Percent A1c STANDARD_DEVIATION 1.587 • n=3483 Participants • Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.	7.327 Percent A1c STANDARD_DEVIATION 2.870 • n=715 Participants • Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.	7.150 Percent A1c STANDARD_DEVIATION 1.543 • n=842 Participants • Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.	7.189 Percent A1c STANDARD_DEVIATION 1.600 • n=825 Participants • Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.	7.168 Percent A1c STANDARD_DEVIATION 1.606 • n=850 Participants • Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.	7.212 Percent A1c STANDARD_DEVIATION 1.784 • n=6715 Participants • Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.

PRIMARY outcome

Timeframe: (1-14) weeks after initial practice orientation

Count of participants that entered data to an electronic glucose flowsheet during the measurement period (Count of participants determined with a binary aggregation method; 1= Participant used Flow Sheet at least once during measurement period; 0= Participant did not use Flow Sheet during Measurement Period)

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin	50 Participants	43 Participants	4 Participants	27 Participants	44 Participants

PRIMARY outcome

Timeframe: 26 weeks after initial practice orientation

Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.

Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. The most recent and available HbA1c test value (percent A1c) in electronic medical records at appropriate time period was used.

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=803 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=765 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3259 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=675 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=784 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Participant A1c Test Results (as Percent A1c) at 26 Weeks	7.227 Percent A1c Standard Deviation 1.731	7.227 Percent A1c Standard Deviation 1.623	7.179 Percent A1c Standard Deviation 1.540	7.327 Percent A1c Standard Deviation 2.894	7.110 Percent A1c Standard Deviation 1.474

SECONDARY outcome

Timeframe: Beginning of week 15 to 26 weeks after initial practice orientation

Count of participants that entered data to an electronic glucose flowsheet during the measurement period (Count of participants determined with a binary aggregation method; 1= Participant used Flow Sheet at least once during measurement period; 0= Participant did not use Flow Sheet during Measurement Period)

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Count of Participants Entering Flowsheet Data During Measurement Period, Extensive Margin	30 Participants	20 Participants	4 Participants	15 Participants	17 Participants

SECONDARY outcome

Timeframe: (1-14); (15-26) weeks after initial practice orientation

The total number of days of participant use of the electronic glucose flowsheet during the measurement period. A day of Participant use of electronic glucose flowsheet is defined here as as day (24 hours) in which the participant performed an entry into an electronic glucose flowsheet.

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Number of Days Participant Used Flowsheet, Intensive Weeks 1-14	0.691 days Standard Deviation 4.683	0.663 days Standard Deviation 5.031	0.011 days Standard Deviation 0.439	0.501 days Standard Deviation 4.281	0.350 days Standard Deviation 2.693
Number of Days Participant Used Flowsheet, Intensive Weeks 15-26	0.502 days Standard Deviation 4.830	0.406 days Standard Deviation 4.338	0.009 days Standard Deviation 0.386	0.353 days Standard Deviation 3.986	0.213 days Standard Deviation 2.865

SECONDARY outcome

Timeframe: at 14 and 26 weeks after initial practice orientation

Count of participants that have an open physician order for electronic glucose flowsheet end of the measurement period (Count of participants determined with a binary aggregation method; 1= Participant had an open physician order for electronic Glucose Flow Sheet at end of measurement period; 0= Participant did not have an open physician order for electronic Glucose Flow Sheet at end of measurement period)

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet Week 14	573 Participants	554 Participants	5 Participants	466 Participants	589 Participants
Count of Participants With an Open Physician Order for Electronic Glucose Flowsheet Week 26	573 Participants	555 Participants	6 Participants	466 Participants	589 Participants

SECONDARY outcome

Timeframe: 14; 26 weeks after initial practice orientation

Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results in their EMR at appropriate timepoint were not included in analysis

The total number of days that elapsed since participant last had and HbA1c test. The number of days was measured by the number of days that passed from the date of the most recent HbA1c test in the Electronic Medical Record and the date of the data extraction at the specified time point.

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=821 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=794 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3352 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=698 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=801 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Number of Days Since Last HbA1c Test Week 26	216.812 days Standard Deviation 229.550	202.957 days Standard Deviation 206.877	196.434 days Standard Deviation 207.394	208.781 days Standard Deviation 215.284	216.949 days Standard Deviation 220.655
Number of Days Since Last HbA1c Test Week 14	210.748 days Standard Deviation 216.562	192.341 days Standard Deviation 192.651	196.369 days Standard Deviation 201.15	196.828 days Standard Deviation 205.93	205.607 days Standard Deviation 213.98

SECONDARY outcome

Timeframe: 14 weeks after initial practice orientation

Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.

Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. The most recent and available HbA1c test value (percent A1c) in electronic medical records at appropriate time period was used

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=821 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=792 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3351 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=698 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=800 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Participant A1c Test Results (as Percent A1c) at 14 Weeks	7.197 Percent A1c Standard Deviation 1.767	7.183 Percent A1c Standard Deviation 1.593	7.196 Percent A1c Standard Deviation 1.601	7.276 Percent A1c Standard Deviation 2.823	7.123 Percent A1c Standard Deviation 1.465

SECONDARY outcome

Timeframe: 14; 26 weeks after initial practice orientation

Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframes. Participants with no test results or with missing values in their EMR at appropriate timepoints were not included in analysis.

Count of participants with improved HbA1c test result values in most recent Electronic Medical Record (EMR) during measurement period as compared to HbA1c test value at baseline. (Count of participants determined with a binary aggregation method; 1= Participant Improved, most recent A1c test value less than baseline A1c test value; 0= Participant did not Improve; most recent A1c test value greater than or equal to baseline A1c test value) Improvement of HbA1c test results is defined as a reduction of the most recent and available HbA1c test value (a lower percent A1c) in the EMR at appropriate time period relative to the baseline. Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. Higher percent A1c levels are associated with poor blood sugar control and increased risk of of diabetes-related complications.

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=818 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=790 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3333 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=693 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=796 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Count of Participants With Improvement of HbA1c Test Results At Week 14	147 Participants	160 Participants	666 Participants	155 Participants	158 Participants
Count of Participants With Improvement of HbA1c Test Results At Week 26	215 Participants	204 Participants	961 Participants	195 Participants	229 Participants

SECONDARY outcome

Timeframe: 14; 26 weeks after initial practice orientation

Population: Data reported only for participants with available A1c test results in their Electronic Medical Record (EMR) during appropriate timeframe. Participants with no test results or with missing values in their EMR at appropriate timepoint were not included in analysis.

Count of participants with most recent HbA1c test value (percent A1c) in Electronic Medical Records below target benchmark of 7 at appropriate time point (Count of participants determined with a binary aggregation method; 1= Participant HbA1c test value less than 7; 0= Participant Hb1Ac test value greater than or equal to 7). Percent A1c represents average blood sugar levels as determined by Hemoglobin A1c (HbA1c) test. The HbA1c test measures what percentage of hemoglobin proteins in blood are glycated. A percent A1c level less than 7 is a common treatment target and is associated with with a lower risk of diabetes-related complications.

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=821 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=792 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3351 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=698 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=800 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Count of Participants With Percent A1c Below Benchmark of 7 At Week 14	458 Participants	442 Participants	1846 Participants	388 Participants	453 Participants
Count of Participants With Percent A1c Below Benchmark of 7 At Week 26	443 Participants	421 Participants	1799 Participants	368 Participants	453 Participants

SECONDARY outcome

Timeframe: (1-14); (15-26) weeks after initial practice orientation

Total number of messages sent by participant via MyChart Electronic medical records system during the measurement period

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Total Secure Messages Sent by Participant Weeks 1-14	1.571 number of messages Standard Deviation 3.282	1.434 number of messages Standard Deviation 2.638	1.385 number of messages Standard Deviation 3.016	1.407 number of messages Standard Deviation 2.872	1.528 number of messages Standard Deviation 3.272
Total Secure Messages Sent by Participant Weeks 15-26	1.135 number of messages Standard Deviation 2.597	1.037 number of messages Standard Deviation 2.338	1.128 number of messages Standard Deviation 2.65	1.226 number of messages Standard Deviation 2.803	1.077 number of messages Standard Deviation 2.496

SECONDARY outcome

Timeframe: (1-14); (15-26) weeks after initial practice orientation

Population: Data not collected.

Total number of MyChart messages sent by patient to the Primary Care Provider (PCP) during the measurement period. Not reported separately from Total number of messages sent by patient, so outcomes not reported here.

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: (1-14); (15-26) weeks after initial practice orientation

Population: Data not collected.

Total number of MyChart messages sent by PCP to the patient during the measurement period

Outcome measures

Outcome data not reported

SECONDARY outcome

Timeframe: (1-14); (1-26) weeks after initial practice orientation

Total number of participant phone appointments during the measurement period

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Total Number of Participant Phone Appointments Weeks 1-14	0.765 number of phone appointments Standard Deviation 1.432	0.849 number of phone appointments Standard Deviation 1.654	0.792 number of phone appointments Standard Deviation 1.651	0.827 number of phone appointments Standard Deviation 1.64	0.789 number of phone appointments Standard Deviation 1.613
Total Number of Participant Phone Appointments Weeks 1-26	1.434 number of phone appointments Standard Deviation 2.420	1.485 number of phone appointments Standard Deviation 2.525	1.442 number of phone appointments Standard Deviation 2.547	1.457 number of phone appointments Standard Deviation 2.417	1.398 number of phone appointments Standard Deviation 2.506

SECONDARY outcome

Timeframe: (1-14); (1-26) weeks after initial practice orientation

Total number of participant in-person appointments during the measurement period

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Total Number of Participant In-person Appointments Weeks 1-14	1.191 number of appointments Standard Deviation 2.991	1.109 number of appointments Standard Deviation 2.782	1.275 number of appointments Standard Deviation 3.476	1.314 number of appointments Standard Deviation 3.914	1.251 number of appointments Standard Deviation 3.580
Total Number of Participant In-person Appointments Weeks 1-26	2.188 number of appointments Standard Deviation 4.452	2.083 number of appointments Standard Deviation 4.652	2.326 number of appointments Standard Deviation 5.322	2.358 number of appointments Standard Deviation 5.4	2.153 number of appointments Standard Deviation 4.775

SECONDARY outcome

Timeframe: (1-14); (1-26) weeks after initial practice orientation

Count of Participants with Changes (Any; Addition; Removal) to list of active medications in EMR during measurement period. Active medication lists is comprised of prescription ordered medications for participants. Count of participants determined with a binary aggregation method: Any Change is defined as medications added or removed from active list ( 1= Participant had medications added to or removed from active medication list; 0= Participant did not have medication added to or removed from active medication list). Medications Added is defined as the addition of medications to active medication list ( 1= Participant had medications added to active medication list; 0= Participant did not have medications added to active medication list). Medications Removed is defined as the removal of medications to active medication list ( 1= Participant had medications removed from active medication list; 0= Participant did not have medications removed from active medication list).

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Count of Participants With Changes to Active Medication List Any Change - Weeks 1-14	140 Participants	141 Participants	742 Participants	135 Participants	133 Participants
Count of Participants With Changes to Active Medication List Any Change - Weeks 1-26	251 Participants	223 Participants	1132 Participants	198 Participants	199 Participants
Count of Participants With Changes to Active Medication List Medication Added - Weeks 1-14	137 Participants	137 Participants	709 Participants	129 Participants	131 Participants
Count of Participants With Changes to Active Medication List Medication Added - Weeks 1-26	247 Participants	214 Participants	1087 Participants	188 Participants	188 Participants
Count of Participants With Changes to Active Medication List Medication Removed - Weeks 1-14	77 Participants	75 Participants	395 Participants	71 Participants	73 Participants
Count of Participants With Changes to Active Medication List Medication Removed - Weeks 1-26	121 Participants	117 Participants	555 Participants	96 Participants	95 Participants

SECONDARY outcome

Timeframe: (1-14); (1-26) weeks after initial practice orientation

Number of prescription ordered medications for participant during measurement period (Total all; Total new/non-refill; Total diabetes related)

Outcome measures

Outcome measures
Measure	2d: Practice Orientation- Physician Reminder n=888 Participants Participants in this group will receive biweekly reminders, addressed from their physician, encouraging them to enter glucose measurements in the electronic flowsheets (Note that though messages will be addressed from physician, they will be sent by Inova IT).	2c: Practice Orientation- Gift Card Reminder n=866 Participants Participants in this group will receive generic biweekly reminders to enter data, addressed from Inova Medical Group, that will also notify that the patient will be entered to win a $50 gift card for each day entering data.	1: Control n=3641 Participants A randomly selected half of primary care practices in the study sample at Inova Health Care Services will not receive any intervention and patients/physicians located at these practices will continue with business as usual.	2a: Practice Orientation- No Reminder n=762 Participants Participants assigned to this group will receive no additional reminder messaging to enter glucose measurements in the electronic flowsheets.	2b: Practice Orientation- Standard Reminder n=895 Participants Participants in this group will receive generic biweekly reminders, addressed from Inova Medical Group, to enter glucose measurements in the electronic flowsheets
Prescription Orders Number of Total Prescription Orders - Weeks 1-14	4.259 number of orders Standard Deviation 12.866	4.733 number of orders Standard Deviation 18.286	5.111 number of orders Standard Deviation 19.825	5.912 number of orders Standard Deviation 19.041	4.488 number of orders Standard Deviation 13.612
Prescription Orders Number of Total Prescription Orders - Weeks 1-26	7.795 number of orders Standard Deviation 20.211	8.242 number of orders Standard Deviation 31.365	9.296 number of orders Standard Deviation 32.904	10.554 number of orders Standard Deviation 33.799	8.050 number of orders Standard Deviation 22.783
Prescription Orders Number of Non-Refill Orders - Weeks 1-14	4.259 number of orders Standard Deviation 12.866	4.733 number of orders Standard Deviation 18.286	5.111 number of orders Standard Deviation 19.825	5.192 number of orders Standard Deviation 19.041	4.488 number of orders Standard Deviation 13.612
Prescription Orders Number of Non-Refill Orders - Weeks 1-26	7.795 number of orders Standard Deviation 20.211	8.242 number of orders Standard Deviation 31.365	9.296 number of orders Standard Deviation 32.904	10.544 number of orders Standard Deviation 33.799	8.050 number of orders Standard Deviation 22.783
Prescription Orders Number of Diabetes Related Prescription Orders - Weeks 1-14	0.574 number of orders Standard Deviation 1.335	0.691 number of orders Standard Deviation 1.749	0.678 number of orders Standard Deviation 2.218	0.718 number of orders Standard Deviation 1.686	0.591 number of orders Standard Deviation 1.605
Prescription Orders Number of Diabetes Related Prescription Orders - Weeks 1-26	1.063 number of orders Standard Deviation 2.055	1.162 number of orders Standard Deviation 2.756	1.28 number of orders Standard Deviation 3.592	1.318 number of orders Standard Deviation 2.938	1.036 number of orders Standard Deviation 2.311

SECONDARY outcome

Timeframe: 2; 4; 6; 8; 10; 12; 14; 18; 22; 26 weeks after initial orientation meeting

Population: Data not collected.

Value of blood glucose entered into flowsheet (descriptive analysis). No systematic outcomes recorded to report.