Employing the Electronic Health Record to Improve Diabetes Care: A Multifaceted Intervention in an Integrated Delivery System

Weber, Valerie; Bloom, Frederick J.; Pierdon, Steve; Wood, Craig

doi:10.1007/s11606-007-0439-2

Cited by 95 publications

(66 citation statements)

References 7 publications

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“…41 GHS also has a diabetes system of care for persons with diabetes that includes expectations that providers will measure HbA1c every 6 months and maintain HbA1c < 7.0%, in addition to monitoring and setting targets for other measures, such as cholesterol, blood pressure, urine protein, vaccinations, and smoking status. 42,43 While weight management is not a targeted measure, providers participating in this system of care are probably also counseling patients about the importance of weight control in T2DM. This system of care was well established at the time of the study, and diabetes care was not likely to differ by drug class and thus not likely to bias the effect of drug selection on weight loss.…”

Section: Limitationsmentioning

confidence: 99%

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

McAdam‐Marx¹,

Bellows²,

Unni³

et al. 2014

JMCP

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BACKGROUND: Managed care organizations put great effort into managing the population of patients with type 2 diabetes mellitus (T2DM) because of the health and economic burden of this disease. In patients with T2DM, weight loss and glycemic control are primary treatment aims to help improve patient outcomes, but these goals are not easily achieved. While achieving these aims requires a multifaceted approach of drug therapy management and lifestyle modification, truly understanding the role of medication adherence in achieving these outcomes is important for both patient and population management. This study expands on existing evidence that weight loss is associated with improved glycemic control by examining the role of medication adherence in achieving these goals in a managed care setting. This study is unique in that these associations are evaluated using multiple sources of data, including medical records for treatment outcomes, pharmacy claims, and patient-reported data to assess medication adherence. These data sources represent those typically available to payers or providers.OBJECTIVE: To describe the relationships between medication and adherence, weight change, and glycemic control in patients with T2DM.METHODS: This historical cohort study included adult patients with T2DM in a large integrated health system and was based on electronic health record and pharmacy claims data from November 1, 2010, through October 31, 2011, as well as data from a self-reported adherence survey conducted in March 2012. Included patients received a diabetes medication from a therapeutic class not previously received, between November 1, 2010, and April 30, 2011 (index date), who had blood glucose (HbA1c) and weight values at index date and 6 months follow-up, participated in an adherence survey, and had ≥ 1 prescription claim for the index-date drug. Associations between the dual outcomes of weight loss (≥ 3%) and HbA1c control (< 7.0%), while controlling for medication adherence and other demographic, treatment, and clinical variables, were evaluated using structural equation models (SEM). Separate models adjusted for different measures of medication adherence-self-reported using the 5-item Medication Adherence Rating Scale (MARS-5) and a modified medication possession ratio (mMPR) from pharmacy claims data. RESULTS:The study included 166 patients with a mean age of 61.1 (standard deviation = 12.1) years; 56.0% were female. Medication adherence was high, with 72.2% adherent using MARS-5 and 77.1% using mMPR measures. The SEMs found that only self-reported medication adherence is associated with weight loss (MARS-5: OR = 1.70, 95% CI = 1.11-2.60), while both self-reported and claims-based medication adherence were associated with HbA1c < 7.0% (MARS-5: OR = 1.59, 95% CI = 1.09-2.34; mMPR: OR 2.71, 95% CI = 1.22-5.98). Further, weight loss is significantly associated with HbA1c < 7.0% (MARS-5: OR = 3.60, 95% CI = 2.39-5.46; mMPR: OR 2.99, 95% CI = 1.45-6.17).CONCLUSIONS: This study has provided additional evidence ...

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Section: Limitationsmentioning

confidence: 99%

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

McAdam‐Marx¹,

Bellows²,

Unni³

et al. 2014

JMCP

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“…There were statistically significant improvements in all individual metrics, including the intermediate outcomes of A1C, LDL, and blood pressure control, in the first year compared to the previous baseline year. 8 After the first year, the improvements on the process measures of lab specimen collection and immunization were sustained. The improvement in smoking status was likely a function of better documentation (since no documentation was considered the same as current smoking), and this was sustained.…”

Section: Resultsmentioning

confidence: 99%

“…The all-or-none bundle score and all nine process and mediating measures improved within the first year of implementation and consistently thereafter. 8 Our experience suggests that an all-or-none diabetes bundle can be an effective internal quality improvement tactic, offering a metric for achieving improved team-based care and improvements in intermediate outcomes in diabetes.…”

Section: In Briefmentioning

confidence: 98%

Redesign of a Diabetes System of Care Using an All-or-None Diabetes Bundle to Build Teamwork and Improve Intermediate Outcomes

Bloom¹,

Graf²,

Anderer³

et al. 2010

Diabetes Spectrum

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In Brief Providing diabetes patients all of the care recommended by current guidelines is a clinical challenge. Geisinger Health System has designed a provider-led, team-based system of care to more consistently and reliably meet this challenge. This system of care uses an all-or-none bundle of diabetes measures and electronic health record tools to improve both process measures and intermediate diabetes outcomes.

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“…Finally, investigators at Geisinger Health System tested a multifaceted intervention to improve physician performance in diabetes mellitus care. 165 Using EHR-facilitated audit and feedback, computerized reminders, and financial incentives, investigators demonstrated significant improvements in glucose control, blood pressure control, and vaccination use among diabetic patients.…”

Section: Lhss and Clinical Trialsmentioning

confidence: 99%

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Maddox¹,

Albert²,

Borden³

et al. 2017

Circulation

118

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ABSTRACT:The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.H ealth care has never been more complex. Clinicians and patients must make decisions that integrate the continually evolving scientific evidence base with hundreds of individual data points such as patients' vital signs, symptoms, comorbidities, medications, test results, and preferences. Furthermore, once these decisions are made, little information is available about their impact, limiting the ability to learn from and ultimately improve care delivery. This inability of the healthcare system to learn from its operation results in significant inefficiencies, substantial costs, and suboptimal health outcomes.The creation of a learning healthcare system (LHS) can potentially address these issues. The LHS uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery 1,2 (Figure 1). Thus, the LHS enables rapid, iterative learning in which "evidence informs practice, and practice informs evidence." 2 The authors argued that recent advances in information processing and connectivity, healthcare organizational design, and reimbursement policies centered on quality rather than quantity of care provided the necessary tools for the creation of the LHS. Accordingly, they called for systematic redesign of the healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture.

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Employing the Electronic Health Record to Improve Diabetes Care: A Multifaceted Intervention in an Integrated Delivery System

Cited by 95 publications

References 7 publications

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

Impact of Adherence and Weight Loss on Glycemic Control in Patients with Type 2 Diabetes: Cohort Analyses of Integrated Medical Record, Pharmacy Claims, and Patient-Reported Data

Redesign of a Diabetes System of Care Using an All-or-None Diabetes Bundle to Build Teamwork and Improve Intermediate Outcomes

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

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