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Randomized Controlled Trial
. 2011 Jan-Feb;9(1):12-21.
doi: 10.1370/afm.1196.

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

Patrick J O'Connor  1 , Joann M Sperl-Hillen, William A Rush, Paul E Johnson, Gerald H Amundson, Stephen E Asche, Heidi L Ekstrom, Todd P Gilmer
Affiliations
Randomized Controlled Trial

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

Patrick J O'Connor et al. Ann Fam Med. 2011 Jan-Feb.

Abstract

Purpose: We wanted to assess the impact of an electronic health record-based diabetes clinical decision support system on control of hemoglobin A(1c) (glycated hemoglobin), blood pressure, and low-density lipoprotein (LDL) cholesterol levels in adults with diabetes.

Methods: We conducted a clinic-randomized trial conducted from October 2006 to May 2007 in Minnesota. Included were 11 clinics with 41 consenting primary care physicians and the physicians' 2,556 patients with diabetes. Patients were randomized either to receive or not to receive an electronic health record (EHR)-based clinical decision support system designed to improve care for those patients whose hemoglobin A(1c), blood pressure, or LDL cholesterol levels were higher than goal at any office visit. Analysis used general and generalized linear mixed models with repeated time measurements to accommodate the nested data structure.

Results: The intervention group physicians used the EHR-based decision support system at 62.6% of all office visits made by adults with diabetes. The intervention group diabetes patients had significantly better hemoglobin A(1c) (intervention effect -0.26%; 95% confidence interval, -0.06% to -0.47%; P=.01), and better maintenance of systolic blood pressure control (80.2% vs 75.1%, P=.03) and borderline better maintenance of diastolic blood pressure control (85.6% vs 81.7%, P =.07), but not improved low-density lipoprotein cholesterol levels (P = .62) than patients of physicians randomized to the control arm of the study. Among intervention group physicians, 94% were satisfied or very satisfied with the intervention, and moderate use of the support system persisted for more than 1 year after feedback and incentives to encourage its use were discontinued.

Conclusions: EHR-based diabetes clinical decision support significantly improved glucose control and some aspects of blood pressure control in adults with type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT00272402.

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Figures

Figure 1.
Figure 1.
Example of Diabetes Wizard.
Figure 2.
Figure 2.
Diagram illustrating randomization and disposition of clinics, primary care physicians, and diabetes patients.
Figure 3.
Figure 3.
Diabetes Wizard use during and after intervention for the intervention group only.
See this image and copyright information in PMC

References

    1. Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is glycemic control improving in U.S. adults? Diabetes Care. 2008;31(1):81–86. - PubMed
    1. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA. 2004;291(3):335–342. - PubMed
    1. Parchman ML, Pugh JA, Romero RL, Bowers KW. Competing demands or clinical inertia: the case of elevated glycosylated hemoglobin. Ann Fam Med. 2007;5(3):196–201. - PMC - PubMed
    1. Karter AJ, Parker MM, Moffet HH, Ahmed AT, Schmittdiel JA, Selby JV. New prescription medication gaps: a comprehensive measure of adherence to new prescriptions. Health Serv Res. 2009;44(5 Pt 1): 1640–1661. - PMC - PubMed
    1. Bolen SD, Bricker E, Samuels TA, et al. Factors associated with intensification of oral diabetes medications in primary care provider-patient dyads: a cohort study. Diabetes Care. 2009;32(1):25–31. - PMC - PubMed

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