Development of a Diabetes Mellitus Knowledge Resource for Clinical Decision Support Assisting Primary Care Physicians With Work-Related Issues

Abstract

Objective To describe the process by which a group of subject matter experts (SMEs) in the area of occupational health and primary care developed a clinical decision support (CDS) tool addressing work-related issues, which are important in the care of patients with diabetes mellitus (DM). The CDS is intended for primary care clinicians caring for employed adults with DM. Methods The SME’s selected guidelines for the management of DM in working adults, reviewed pertinent literature, and developed specific recommendations for action in the clinical setting. Results Multiple factors at work may adversely affect DM management. Clinicians can support working patients through education and care strategies to improve control. Conclusions Improved recognition of factors at work that can have an impact on DM care provides opportunities for improved management of DM among working adults.

Enhancing Worker Health Through Clinical Decision Support (CDS)

“…The paper by Harber et al 13 describes an approach for work-related asthma triggered by a diagnosis of asthma or emergency room, acute clinic visit, or hospitalization for asthma in an adult in the past two years. 13 Allen et al 14 describe the process of developing a recommendation around recognition of factors at work that impact diabetes care and management among working adults, triggered by an HbA1c laboratory value. 14 The paper by McLellan et al 15 describes development of an activity prescription tool to assist with return-to-work associated with acute low back pain not caused by work, triggered by a request or requirement from a patient for an activity note.…”

“…13 Allen et al 14 describe the process of developing a recommendation around recognition of factors at work that impact diabetes care and management among working adults, triggered by an HbA1c laboratory value. 14 The paper by McLellan et al 15 describes development of an activity prescription tool to assist with return-to-work associated with acute low back pain not caused by work, triggered by a request or requirement from a patient for an activity note. 15 Lastly, the paper by Baron et al 12 describes the input obtained from PCPs and staff at five heterogeneous and geographically dispersed primary care practices regarding the proposed CDS.…”

Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

“…Details of the development of the KRs and their contents have been described elsewhere. [11][12][13][14][15] The primary care context within which the CDS described in the KRs would be implemented was expected to impact its usefulness and primary care was not represented in the SME groups that developed the KRs. Therefore, we designed a field study in primary care clinics to gain a picture of the environment and to assess the need.…”

Electronic Health Records and Occupational Data

“…13 Understanding a patient's work also can help the clinician better assess the role of factors, such as shift work or lack of proper storage for medications, that should influence the management of chronic diseases. 14 The US Center for Disease Control and Prevention's early Healthy People agenda included improving the collection of an occupational history as a national healthcare goal, but with little success. Occupational health data elements were present in only 27.8% of records at a major US academic medical center.…”

“…A physician’s knowledge of a patient’s work history, job hazards, and current job duties is foundational for accurate diagnosis, treatment, prevention of work-related conditions, and facilitating prompt and safe return to work 13 . Understanding a patient’s work also can help the clinician better assess the role of factors, such as shift work or lack of proper storage for medications, that should influence the management of chronic diseases 14 . The US Center for Disease Control and Prevention’s early Healthy People agenda included improving the collection of an occupational history as a national healthcare goal, but with little success.…”