The Vermont Diabetes Information System: A Cluster Randomized Trial of a Population Based Decision Support System

Abstract

BACKGROUND:Optimal care for patients with diabetes is difficult to achieve in clinical practice. OBJECTIVE:To evaluate the impact of a registry and decision support system on processes of care, and physiologic control.PARTICIPANTS: Randomized trial with clustering at the practice level, involving 7,412 adults with diabetes in 64 primary care practices in the Northeast. INTERVENTIONS:Provider decision support (reminders for overdue diabetes tests, alerts regarding abnormal results, and quarterly population reports with peer comparisons) and patient decision support (reminders and alerts). MEASUREMENTS AND MAIN RESULTS:Process and physiologic outcomes were evaluated in all subjects. Functional status was evaluated in a random patient sample via questionnaire. We used multiple logistic regression to quantify the effect, adjusting for clustering and potential confounders. Intervention subjects were significantly more likely to receive guideline-appropriate testing for cholesterol (OR=1.39; [95%CI 1.07, 1.80] P=0.012), creatinine (OR=1.40; [95%CI 1.06, 1.84] P=0.018), and proteinuria (OR=1.74; [95%CI 1.13, 1.69] P=0.012), but not A1C (OR=1.17; [95% CI 0.80, 1.72] P = 0.43). Rates of control of A1C and LDL cholesterol were similar in the two groups. There were no differences in blood pressure, body mass index, or functional status. CONCLUSIONS:A chronic disease registry and decision support system based on easily obtainable laboratory data was feasible and acceptable to patients and providers. This system improved the process of laboratory monitoring in primary care, but not physiologic control.

The Effects of Computerized Clinical Decision Support Systems on Laboratory Test Ordering: A Systematic Review

“…[20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Eight studies (35%) were conducted in Europe. 23,[38][39][40][41][42][43][44][45] One study (4%) was conducted in Europe and Australia.…”

“…46,47 Thirteen studies (57%) evaluated CCDSSs in primary care,* 5 (22%) in hospital outpatient ambulatory care, 26,31,33,36,44 and 5 (22%) in hospital inpatient care. 22,25,32,34 Intervention.-Fifteen different CCDSSs were studied, of which 6 (40%) were focused solely on laboratory testing, † 5 (33%) also included other reminders such as treatment options, [27][28][29]31,39,[41][42][43] and 4 (27%) were not stand-alone systems, but were developed by an EHR software vendor. ‡ Of the CCDSSs focused solely on laboratory testing, 3 (50%) were targeted at regulating blood clotting in patients using anticoagulants.…”

“…MacLean et al 27,28 studied the Vermont Diabetes Information System (Burlington, Vermont), which generates reminders based on the results from independent laboratories and sends these to the primary care physicians either through the EHR, by fax, or by mail, depending on their network capabilities. 43 studied a CCDSS service for the implementation of guidelines on diabetes and hypertension, including recommendations on diagnostics and laboratory tests.…”

Informing the development of a national diabetes register in Ireland: a literature review of the impact of patient registration on diabetes care

“…[11][12][13][14][15] All studies examined the processes of care and outcome measures. Although improvements in processes of care were found, the trend for significant improvement in clinical outcomes was modest.…”

The Impact of Low Health Literacy in an Older HIV Patient

“…In the United States, individuals over the age of 55 alarmingly accounted for 19% (217,300) of the estimated 1.1 million people living with the HIV infection, which places them at risk for mismanaging their HIV health care regimen due to possible low health literacy levels [3]. Studies have illustrated that those individuals with low health literacy have decreased levels of knowledge about their illness in general [4][5][6]. Health literacy can negatively affect how a person navigates the health care system, communicates information to health care providers, engages in self-care and disease management, and utilizes formal health care services [7].…”