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

From Clinfowiki
Jump to: navigation, search

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. [1]


Background

Primary-care providers deliver majority (80%) of diabetes treatment and care. There is a need to improve strategies via 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. [1]

  • 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 [2] [3]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.[4]

References

  1. ↑ 1.0 1.1 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
  2. ↑ Intitute for Clnical Systems Improvement (ICSI). Diagnosis and Management of Type 2 Diabetes Mellitus in Adults. Bloomington, MN, Institute for Clinical Systems Improvement; 2009.
  3. ↑ 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.
  4. ↑ 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
Retrieved from "http://clinfowiki.org/wiki/index.php?title=Impact_of_electronic_health_record_clinical_decision_support_on_diabetes_care:_a_randomized_trial&oldid=21708"