Implementing and feasibility testing depression screening using the electronic medical record for patients with type 2 diabetes admitted to the hospital

Purpose The purpose of this study is to identify patient-specific factors, easily obtainable from the electronic medical record (EMR), that are associated with nonattendance to a group Diabetes Self-Management Education and Support (DSMES) program among an adult population with type 2 diabetes. Methods This study used a retrospective cohort design, with attendance to a group DSMES session as the primary outcome. The study included adult patients with diagnosed type 2 diabetes who were scheduled for a group DSMES session between March 1, 2013, and June 30, 2017. Patients who were pregnant or who had other types of diabetes (eg, type 1 diabetes, prediabetes, gestational diabetes) were excluded. Results A higher A1C, required copay for DSMES, low socioeconomic status, increased number of diabetes medications prescribed, the presence of a prescription for any insulin, and a higher calculated total daily dose of insulin were all associated with a decreased likelihood of attendance. Only older age was associated with an increased likelihood of attendance. Conclusion Using the EMR to identify patients who need more intensive intervention strategies can help programs direct resources to those who need them most. Having identified these at-risk individuals, a targeted communication and outreach strategy can be developed to assist these individuals with overcoming barriers to attending DSMES.

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Use of an Electronic Medical Record (EMR) to Identify Glycemic Intensification Strategies in Type 2 Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/1932296814564183 ◽

2014 ◽

Vol 9 (3) ◽

pp. 593-601 ◽

Cited By ~ 2

Author(s):

Mary T. Korytkowski ◽

Maria Brooks ◽

Manuel Lombardero ◽

Dilhari DeAlmeida ◽

Justin Kanter ◽

...

Keyword(s):

Type 2 Diabetes ◽

Medical Record ◽

Electronic Medical Record

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Electronic Medical Record Risk Modeling of Cardiovascular Outcomes Among Patients with Type 2 Diabetes

Diabetes Therapy ◽

10.1007/s13300-021-01096-w ◽

2021 ◽

Author(s):

Dongzhe Hong ◽

Daniel Fort ◽

Lizheng Shi ◽

Eboni G. Price-Haywood

Keyword(s):

Type 2 Diabetes ◽

Medical Record ◽

Electronic Medical Record ◽

Cardiovascular Outcomes ◽

Risk Modeling

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Guiding Glucose Management Discussions Among Adults With Type 2 Diabetes in General Practice: Development and Pretesting of a Clinical Decision Support Tool Prototype Embedded in an Electronic Medical Record

JMIR Formative Research ◽

10.2196/17785 ◽

2020 ◽

Vol 4 (9) ◽

pp. e17785

Author(s):

Breanne E Kunstler ◽

John Furler ◽

Elizabeth Holmes-Truscott ◽

Hamish McLachlan ◽

Douglas Boyle ◽

...

Keyword(s):

Type 2 Diabetes ◽

Decision Support ◽

Medical Record ◽

Electronic Medical Record ◽

Clinical Decision Support ◽

Pharmacological Treatment ◽

Design Method ◽

Clinical Decision ◽

Treatment Intensification

Background Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options. Objective This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations. Methods The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification. Results Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities. Conclusions GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.

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Improving Management of People with Type 2 Diabetes Using Digital Tools (Preprint)

10.2196/preprints.24687 ◽

2020 ◽

Author(s):

Richard Milani

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Usual Care ◽

Medical Record ◽

Electronic Medical Record ◽

Home Based ◽

Digital Medicine ◽

One Year ◽

The Impact

BACKGROUND Diabetes is present in 10.5% of the U.S. population and accounts for 14.3% of all office-based physician visits made by adults. Despite this established office-based approach, the disease and its adverse outcomes, including glycemic control and clinical events, tend to worsen over time. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. OBJECTIVE To evaluate the impact of a virtual, home-based diabetes management program on clinical measures of diabetes control compared to usual care. METHODS We evaluated glycemic control and other diabetes-related measures after one year in 763 patients with type 2 diabetes enrolled into a home-based digital medicine diabetes program and compared them to 794 patients matched for age, sex, race, BMI, A1C, creatinine, eGFR, and insulin use in a usual care group after one year. Digital medicine patients completed questionnaires on-line, received medication management and lifestyle recommendations from a clinical pharmacist or APP and a health coach, and were asked to submit blood glucose readings using a commercially available Bluetooth enabled glucose meter that transmitted data directly to the electronic medical record. RESULTS After one-year, usual care patients demonstrated no significant changes in A1C (7.3±1.7 to 7.3±1.6; P =.41), or in the proportion of patients with A1C ≥ 9.0 (15% to 14%; P = .51). Digital medicine patients demonstrated improvements in A1C (7.3±1.5 to 6.9±1.2; P <.001), the proportion of patients with A1C ≥ 9.0 (14% to 6%; P <.001), diabetes distress (26% to 16%; P <.001), and in hypoglycemic episodes (41.1% to 11.9%; P <.001). CONCLUSIONS A digital diabetes program is associated with significant improvement in glycemic control and other diabetes measures. Utilization of a virtual health intervention using connected devices was widely accepted across a broad range of ethnic diversity, ages, and levels of health literacy.

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