Impact of a Diabetes Electronic Management System on the Care of Patients Seen in a Subspecialty Diabetes Clinic

Smith, Steven A.; Murphy, Mary E.; Huschka, Todd R.; Dinneen, Séan F.; Gorman, Colum A.; Zimmerman, Bruce R.; Rizza, Robert A.; Naessens, James M.

doi:10.2337/diacare.21.6.972

Cited by 62 publications

(37 citation statements)

References 23 publications

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“…Prior research suggests beneficial effects of diabetes disease management programs or computer decision support systems (17)(18)(19)22,24,31,32), but lack of rigorous control in many of these studies prevents reliable discrimination of intervention effects from the background secular improvements in levels of HbA 1c , blood pressure, and lipids occurring nationwide (33)(34)(35)(36). The specific benefits of computer aids to diabetes care are gradually becoming rigorously documented.…”

Section: Effects Of the Interventionmentioning

confidence: 99%

A Controlled Trial of Web-Based Diabetes Disease Management

et al. 2003

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OBJECTIVE -To test effects of a web-based decision support tool, the diabetes Disease Management Application (DMA), developed to improve evidence-based management of type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a group randomized controlled trial of 12 intervention and 14 control staff providers and 307 intervention and 291 control patients with type 2 diabetes in a hospital-based internal medicine clinic. Providers were randomly assigned from May 1998 through April 1999 to have access to the DMA (intervention) or not to have access (control). The DMA displays interactive patient-specific clinical data, treatment advice, and links to other web-based care resources. We compared patients in the intervention and control groups for changes in processes and outcomes of care from the year preceding the study through the year of the study by intention-to-treat analysis.RESULTS -The DMA was used for 42% of scheduled patient visits. The number of HbA 1c tests obtained per year increased significantly in the intervention group (ϩ0.3 tests/year) compared with the control group (Ϫ0.04 tests/year, P ϭ 0.008), as did the number of LDL cholesterol tests (intervention, ϩ0.2 tests/year; control, ϩ0.01 tests/year; P ϭ 0.02) and the proportions of patients undergoing at least one foot examination per year (intervention, ϩ9.8%; control, Ϫ0.7%; P ϭ 0.003). Levels of HbA 1c decreased by 0.2 in the intervention group and increased by 0.1 in the control group (P ϭ 0.09); proportions of patients with LDL cholesterol levels Ͻ130 mg/dl increased by 20.3% in the intervention group and 10.5% in the control group (P ϭ 0.5).CONCLUSIONS -Web-based patient-specific decision support has the potential to improve evidence-based parameters of diabetes care. Diabetes Care 26:750 -757, 2003D iabetes, primarily type 2 diabetes, affects Ͼ12% of the adult U.S. population and has become increasingly common over the past decade (1). Patients with type 2 diabetes are affected by microvascular complications, but cardiovascular disease (CVD) complications take the greatest toll (2). Diabetes and its complications cause substantial loss in quality of life, are the fourth most frequent reason for ambulatory physician visits, and incur Ͼ100 billion dollars in U.S. health care expenditures annually (3-5). There is probably no other common condition with a more pernicious effect than diabetes on patient health and health care budgets.Fortunately, there is now abundant evidence that complications of diabetes are preventable. Simple screening interventions can prevent visual loss and serious foot lesions (6,7), and intensive control of glycemia, blood pressure, and lipid levels slow the incidence and progression of microvascular and CVD complications (8). This evidence provides the basis for diabetes care guidelines promulgated by the American Diabetes Association (ADA) and other expert panels (9 -12). Regrettably, studies consistently document a large gap between evidencebased standards and current diabetes care in the U.S. For instance, only ϳ50% of ...

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Section: Effects Of the Interventionmentioning

confidence: 99%

A Controlled Trial of Web-Based Diabetes Disease Management

et al. 2003

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“…16 The advances in IT have created new opportunities for changes in the design of healthcare delivery. IT has also been used as an information storage system to create diabetes registries 16,17 which can assist GPs to conduct clinical audits. Patients can now upload their blood glucose and blood pressure readings onto their computers and share these with their GP via the internet.…”

Section: Uses Of It To Support Diabetes Carementioning

confidence: 99%

The use of information technology to enhance diabetes management in primary care: a literature review

Adaji¹,

Schattner²,

Jones³

2008

Journal of Innovation in Health Informatics

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“…Furthermore, there is evidence from studies in other chronic diseases [20][21][22][23][24] that integration of electronic technology into such systems can facilitate disease management and positively impact patient outcomes. In summary, interventions that incorporate reminders and education, and those that target both physicians and patients are promising strategies for improving outcomes in osteoporosis disease management.…”

Section: Discussionmentioning

confidence: 99%

“…This list was supplemented by additional terms that were found in studies evaluating tools in other chronic diseases such as heart failure, diabetes, and asthma [20][21][22][23][24] . The final list of terms included clinical decision support systems/techniques/tools; disease management/tools; clinical decision aids/tools/guidelines, computer assisted; decision rules/trees/prediction guides; reminder systems; risk assessment instruments/tools; point of care system.…”

Section: Search Strategymentioning

confidence: 99%

Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

Kastner

Straus

2008

J GEN INTERN MED

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Impact of a Diabetes Electronic Management System on the Care of Patients Seen in a Subspecialty Diabetes Clinic

Abstract: Performance and documentation of the process of care for patients with diabetes in a subspecialty clinic are greater with the use of a DEMS than with the traditional paper record.

Cited by 62 publications

References 23 publications

A Controlled Trial of Web-Based Diabetes Disease Management

A Controlled Trial of Web-Based Diabetes Disease Management

The use of information technology to enhance diabetes management in primary care: a literature review

Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

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