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Randomized Controlled Trial
. 2019 Apr/Jun;42(2):105-115.
doi: 10.1097/JAC.0000000000000267.

Using Electronic Clinical Decision Support in Patient-Centered Medical Homes to Improve Management of Diabetes in Primary Care: The DECIDE Study

James Gill  1 , Kathrin Kucharski, Barbara Turk, Chunshen Pan, Wenhui Wei
Affiliations
Randomized Controlled Trial

Using Electronic Clinical Decision Support in Patient-Centered Medical Homes to Improve Management of Diabetes in Primary Care: The DECIDE Study

James Gill et al. J Ambul Care Manage. 2019 Apr/Jun.

Abstract

This prospective, randomized, real-world study aimed to examine the impact of electronic health record-based clinical decision support (CDS) tools on the management of diabetes in small- to medium-sized primary care practices participating in Delaware's patient-centered medical home project. Overall, use of CDS systems was associated with greater reductions from baseline in hemoglobin A1c and low-density lipoprotein cholesterol, and more patients achieving treatment goals. Physicians and staff reported that the CDS toolkit empowered them to be more involved in clinical decision-making, thereby helping to improve diabetes care. However, all cited significant barriers to fully implementing team-based CDS, predominantly involving time and reimbursement.

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Figures

Figure 1.
Figure 1.
Crimson Care Registry: sample patient encounter form. A1C indicates glycated hemoglobin A1c; BMI, body mass index; BP, blood pressure; LDL, low-density lipoprotein; NIDDM, non-insulin-dependent diabetes mellitus (type 2 diabetes); PCP, primary care provider.
Figure 2.
Figure 2.
Adjusted changes from baseline to 1-year follow-up in A1C (A) and LDL-C (B) in the A1C and LDL-C subgroups, respectively. A1C indicates glycated hemoglobin A1c; CDS, clinical decision support; LDL-C, low-density lipoprotein cholesterol.
Figure 3.
Figure 3.
Odds of achieving A1C and LDL-C goals after 1 year of CDS versus control (in the A1C and LDL-C subgroups, respectively). A1C indicates glycated hemoglobin A1c; CDS, clinical decision support; LDL-C, low-density lipoprotein cholesterol.
See this image and copyright information in PMC

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