Abstract
Early efforts to use point-of-care clinical decision support (CDS) were limited to the use of prompts and reminders, which improved test ordering but not intermediate outcomes of care, such as glucose, blood pressure, or lipid levels. More sophisticated diabetes CDS tools are now available that use electronic medical record data to provide patient-specific advice on medication use on the basis of previous treatment, distance from goal, and other clinical data. These tools have shown modest but significant improvement in glucose and blood pressure control. Promising next-generation developments will include prioritizing clinical actions that have maximum benefit to a given patient at the point of care and developing effective methods to communicate CDS information to patients to better incorporate patient preferences in care decisions.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
DCCT. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329(14):977–86.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53.
UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854–65.
Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA. 2004;291(3):335–42.
Kerr EA, Lucatorto MA, Holleman R, Hogan MM, Klamerus ML, Hofer TP. Monitoring performance for blood pressure management among patients with diabetes mellitus: too much of a good thing? Arch Intern Med. 2012;172(12):938–45.
MNCM. Minnesota Community Measurement. 2011; http://www.mncm.org/site/?page=about. Accessed 9/4/2012.
ADA. Standards of medical care in diabetes. Diabetes Care. 2012;35(S1):.
ICSI. Health care guideline: diagnosis and management of type 2 diabetes mellitus in adults. Minneapolis: Institute for Clinical Systems Improvement; 2010.
Renders CM, Valk GD, Griffin SJ, Wagner EH, Van Eijk JT, Assendelft WJ. Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care. 2001;24(10):1821–33.
Blumenthal D. Launching HITECH. N Engl J Med. 2010;362(5):382–5.
CMS. Centers for Medicare and Medicaid services. Medicare and Medicaid programs; Electronic Health Record Incentive Program; Final Rule. Federal Register ed. Washington, DC: Department of Health and Human Services; 2010. p. 44314–588.
HEALTLH I. Bipartisan policy center task force on delivery system reform and health IT. Transforming health care: the role of health IT2012.
Institute of Medicine. The computer-based patient record. An essential technology for health care. Washington DC: National Academy Press; 1991.
Institute of Medicine. Guidelines for clinical practice. From development to use. Washington DC: National Academy Press; 1992.
Tierney WM, Overhage JM, Murray MD, et al. Effects of computerized guidelines for managing heart disease in primary care. J Gen Intern Med. 2003;18(12):967–76.
Murray MD, Harris LE, Overhage JM, et al. Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial. Pharmacotherapy. 2004;24(3):324–37.
Tierney WM, Overhage JM, Murray MD, et al. Can computer-generated evidence-based care suggestions enhance evidence-based management of asthma and chronic obstructive pulmonary disease? A randomized, controlled trial. Health Serv Res. 2005;40(2):477–98.
Meigs JB, Cagliero E, Dubey A, et al. A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project. Diabetes Care. 2003;26(3):750–7.
Montori VM, Dinneen SF, Gorman CA, et al. The impact of planned care and a diabetes electronic management system on community-based diabetes care: the Mayo Health System Diabetes Translation Project. Diabetes Care. 2002;25(11):1952–7.
Bates DW, Kuperman GJ, Wang S, et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003;10(6):523–30.
Koopman RJ, Kochendorfer KM, Moore JL, et al. A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care. Ann Fam Med. 2011;9(5):398–405.
Barnes CS, Ziemer DC, Miller CD, et al. Little time for diabetes management in the primary care setting. Diabetes Educ. 2004;30(1):126–35.
• O’Connor PJ, Sperl-Hillen JM, Rush WA, et al. Impact of electronic health record clinical decision support on diabetes care: a randomized trial. Ann Fam Med. 2011;9(1):12-–21. This randomized trial showed that point-of-care diabetes clinical decision support was able to modestly but signficantly improve glucose control and some aspects of BP control in adults with diabetes.
Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.
Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.
IOM. Institute of medicine: guidelines we can trust. 2012; http://iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx.
Kung J, Miller R, Mackowiak P. Failure of clinical practice guidelines to meet institute of medicine standards: two more decades of little, if any, progress. Arch Intern Med. 2012;doi:10.1001/2013.jamainternmed.56 (published online October 22, 2012).
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–89.
CDC Diabetes Cost-effectiveness Group. Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. The CDC Diabetes Cost-effectiveness Group. JAMA. 2002;287(19):2542–51.
O’Connor P, Arterburn DE, Bogart A, et al. Impact of bariatric surgery on long-term remission and relapse of type 2 diabetes mellitus: a multi-site study. Diabetes. 2011;60 Suppl 1:A327.
Disclosure
Conflicts of interest: P.J. O’Connor has an NHLBI grant pending; has received honoraria from Peking University, the Montana Diabetes Program, and PCORI; has a patent pending on diabetes decision support but no anticipation of money paid. Desai: none. J. Butler: none. E. Kharbanda: none. J. M. Sperl-Hillen is a nonpaid board member of SimCare Health; has received grant support from Merck & Co. and Pfizer; has received honoraria for the BMJ Guideline, and ADA Editor for Diabetes Spectrum; is listed inventor on a patent for simulation-based provider education; and has received payment for development of educational presentations including service on speakers’ bureaus for travel expenses to speak at diabetes conference for Medical College of Wisconsin; travel expenses have been covered for speaking engagements and abstract/oral presentations.
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O’Connor, P.J., Desai, J.R., Butler, J.C. et al. Current Status and Future Prospects for Electronic Point-of-Care Clinical Decision Support in Diabetes Care. Curr Diab Rep 13, 172–176 (2013). https://doi.org/10.1007/s11892-012-0350-z
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DOI: https://doi.org/10.1007/s11892-012-0350-z