Development of a novel clinical decision support tool for diabetes prevention and feasibility of its implementation in primary care.

Autor:	O'Brien MJ; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States.; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine. 680 N. Lakeshore Drive, 14 Floor, Chicago, IL 60611, United States., Vargas MC; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States., Lopez A; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States., Feliciano Y; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States., Gregory DL; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States., Carcamo P; Erie Family Health Centers. 1701 W. Superior Street, Chicago, IL 60622, United States., Mohr L; Erie Family Health Centers. 1701 W. Superior Street, Chicago, IL 60622, United States., Mohanty N; Erie Family Health Centers. 1701 W. Superior Street, Chicago, IL 60622, United States.; AllianceChicago. 225 W. Illinois Street, 5 Floor, Chicago, IL 60654, United States., Padilla R; AllianceChicago. 225 W. Illinois Street, 5 Floor, Chicago, IL 60654, United States., Ackermann RT; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States., Persell SD; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States., Feinglass J; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States.
Jazyk:	angličtina
Zdroj:	Preventive medicine reports [Prev Med Rep] 2022 Sep 07; Vol. 29, pp. 101979. Date of Electronic Publication: 2022 Sep 07 (Print Publication: 2022).
DOI:	10.1016/j.pmedr.2022.101979
Abstrakt:	Prediabetes impacts 88 million U.S. adults, yet uptake of evidence-based treatment with intensive lifestyle interventions and metformin remains exceedingly low. After incorporating feedback from 15 primary care providers collected during semi-structured interviews, we developed a novel Prediabetes Clinical Decision Support (PreDM CDS) from August 2019 to February 2020. This tool included order options enabling prediabetes management in a single location within the electronic health record. We conducted a retrospective observational study examining the feasibility of implementing this tool at Erie Family Health Centers, a large community health center, examining its use and related outcomes among patients for whom it was used vs not. Overall, 7,424 eligible patients were seen during the implementation period (February 2020 to August 2021), and the PreDM CDS was used for 108 (1.5 %). Using the PreDM CDS was associated with higher rates of hemoglobin A1c orders (70.4 % vs 22.2 %; p < 0.001), lifestyle counseling (38.0 % vs 7.8 %; p < 0.001), and metformin prescription orders (5.6 % vs 2.6 %; p = 0.06). Exploratory analyses revealed small, nonsignificant weight loss among patients for whom the PreDM CDS was used. This study demonstrates the feasibility of developing and implementing the PreDM CDS in primary care. Its low use was likely related to not imposing an interruptive 'pop-up' alert, as well as major changes in workflows and clinical priorities during the Covid-19 pandemic. Use of the tool was associated with improved process outcomes. Future efforts with the PreDM CDS should follow standard CDS implementation processes that were not possible due to the Covid-19 pandemic. Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (© 2022 The Author(s).)
Databáze:	MEDLINE
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