View source for Impact of electronic health record clinical decision support on diabetes care: a randomized trial

Ths is an atricle review of O’Connor, P. J., Sperl-Hillen, J. M., Rush, W. A., Johnson, P. E., Amundson, G. H., Asche, S. E., ... & Gilmer, T. P. (2011). Impact of electronic health record clinical decision support on diabetes care: a randomized trial. The Annals of Family Medicine, 9(1), 12-21. <ref name "oconner"> O’Connor, P. J., Sperl-Hillen, J. M., Rush, W. A., Johnson, P. E., Amundson, G. H., Asche, S. E., ... & Gilmer, T. P. (2011). Impact of electronic health record clinical decision support on diabetes care: a randomized trial. The Annals of Family Medicine, 9(1), 12-21.http://www.annfammed.org/content/9/1/12.short </ref>


==Background==
Primary-care providers deliver majority (80%) of diabetes treatment and care. There is a need to improve strategies via [[CDS|Clinical decision support systems]] (CDSS) in primary-care settings to address control of A1c levels, blood pressure, and LDL cholesterol levels in adults living with diabetes.

==Methods==
This study used a randomized-control trial where patients either received or did not receive an electronic health record customized CDSS for patients with high A1c levels, blood pressure, and LDL cholesterol levels than anticipated.

==Results==
The intervention group showed significantly better A1c levels [Interaction Effect -0.26%; 95% CI (-0.06,0.47); p=.01] and maintained systolic (80.2 % vs 75.1% control group; p=.03) & diastolic (85.6% vs 81.7% control group; p=.07) blood pressure control. However, the intervention group had lower LDL levels (p=.62) than the control group. User satisfaction of primary-care providers for intervention group were satisfied or very satisfied (94%) with the CDSS including feedback of moderate use a year after intervention. 

Summary of ADA-Recommended Treatment Goals for Most Adults with Diabetes. <ref name "Oxendine"> Victoria Oxendine, DNP, FNP-BC, Albert Meyer, MD, FAAFP, Paula V. Reid, PhD, RNC, WHNP-BC, Ashley Adams, BA and Valerie Sabol, PhD, ACNP-BC, GNP-BC. Evaluating Diabetes Outcomes and Costs within an Ambulatory Setting: A Strategic Approach Utilizing a Clinical Decision Support System. http://clinical.diabetesjournals.org/content/32/3/113.full.pdf+html</ref> 
*Blood Pressure - <130/180
*A1C - <7.0
*Total Cholesterol - <200
*Triglycerides (mg/d1) - <150
*HDL Cholesterol (mg/d1) - Women >50; Men >40
*LDL Cholesterol (mg/d1) - <100
*Controlled vs. Uncontrolled Diabetes – Controlled = A1C <7.0% / Uncontrolled = A1C > 7.0%

==Conclusions==
The use of this CDSS helped improve A1c levels and some aspects of blood pressure control in adults living with diabetes.

==Comments==
This article was interesting as it featured a CDSS for more than one measure of diabetes primary-care treatment. As an RCT, it contributed towards the literature and reinforced guidelines <ref name ="ICSI"> Intitute for Clnical Systems Improvement (ICSI). Diagnosis and Management
of Type 2 Diabetes Mellitus in Adults. Bloomington, MN,
Institute for Clinical Systems Improvement; 2009. </ref> 
<ref name="PointofCare">Treatment of Type 2 Diabetes. Online Point of Care clinical decision
support tool marketed as part of BMJ Point of Care. Concise and
practical information on etiology, epidemiology, and clinical management
of type 2 diabetes. 2010. https://online.epocrates.com/u/291124/Type+2+diabetes+mellitus. </ref>for meeting certain levels of A1c, blood pressure, and LDL cholesterol for adults living with diabetes.
Other studies have looked at the outcomes of glycemic control with Type 2 diabetes using clinical decision support as opposed to no access to clinical decision support.<ref name="glycemic control with and without CDS access">The Impact of a Decision Support Tool Linked to an Electronic Medication Record on Glycemic Control in People with Type 2 Diabetes. http://clinfowiki.org/wiki/index.php/The_Impact_of_a_Decision_Support_Tool_Linked_to_an_Electronic_Medical_Record_on_Glycemic_Control_in_People_with_Type_2_Diabetes</ref>

==References==
<references/>


[[category:reviews]]
[[category:CDSS]]