TY - JOUR
T1 - Implementing a prediabetes clinical decision support system in a large primary care system
T2 - Design, methods, and pre-implementation results
AU - Desai, Jay
AU - Saman, Daniel
AU - Sperl-Hillen, Jo Ann M.
AU - Pratt, Rebekah
AU - Dehmer, Steven P.
AU - Allen, Clayton
AU - Ohnsorg, Kris
AU - Wuorio, Allise
AU - Appana, Deepika
AU - Hitz, Paul
AU - Land, Austin
AU - Sharma, Rashmi
AU - Wilkinson, Lisa
AU - Crain, A. Lauren
AU - Crabtree, Benjamin F.
AU - Bianco, Joseph
AU - O'Connor, Patrick J
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/3
Y1 - 2022/3
N2 - Background: Early detection of prediabetes and management of cardiovascular (CV) risk factors to prevent CV disease is essential, but clinicians are often slow to address this risk. Clinical decision support (CDS) systems, with appropriate implementation, can potentially improve prediabetes identification and treatment. Methods/design: 34 Midwestern primary care clinics were randomized to receive or not receive access to a prediabetes (Pre–D) CDS tool. Between October 2016 and December 2019, primary care clinicians (PCPs) received Pre-D CDS alerts during visits with adult patients identified with prediabetes and who met minimal inclusion criteria and had at least one CV risk factor not at goal. The PCP Pre-D CDS included a summary of six modifiable CV risk factors and patient-specific treatment recommendations. Study outcomes included total modifiable CV risk, six modifiable CV risk factors, use of CV medications, and referrals. The Consolidated Framework for Implementation Research was used to examine CDS implementation processes. Discussion: This cluster-randomized pragmatic trial allowed PCPs the opportunity to improve CV risk in a timely manner for patients with prediabetes. Effectiveness will be assessed using an intent-to-treat analysis. Implementation processes and outcomes will be assessed through interviews, surveys, and electronic health record data harvested by the CDS tool itself. Pre-implementation interviews and activities identified key strategies to incorporate as part of the Pre-D CDS implementation process to ensure acceptability and high use rates. Analyses are ongoing and trial results are expected in mid-2021.
AB - Background: Early detection of prediabetes and management of cardiovascular (CV) risk factors to prevent CV disease is essential, but clinicians are often slow to address this risk. Clinical decision support (CDS) systems, with appropriate implementation, can potentially improve prediabetes identification and treatment. Methods/design: 34 Midwestern primary care clinics were randomized to receive or not receive access to a prediabetes (Pre–D) CDS tool. Between October 2016 and December 2019, primary care clinicians (PCPs) received Pre-D CDS alerts during visits with adult patients identified with prediabetes and who met minimal inclusion criteria and had at least one CV risk factor not at goal. The PCP Pre-D CDS included a summary of six modifiable CV risk factors and patient-specific treatment recommendations. Study outcomes included total modifiable CV risk, six modifiable CV risk factors, use of CV medications, and referrals. The Consolidated Framework for Implementation Research was used to examine CDS implementation processes. Discussion: This cluster-randomized pragmatic trial allowed PCPs the opportunity to improve CV risk in a timely manner for patients with prediabetes. Effectiveness will be assessed using an intent-to-treat analysis. Implementation processes and outcomes will be assessed through interviews, surveys, and electronic health record data harvested by the CDS tool itself. Pre-implementation interviews and activities identified key strategies to incorporate as part of the Pre-D CDS implementation process to ensure acceptability and high use rates. Analyses are ongoing and trial results are expected in mid-2021.
KW - Cardiovascular risk factors
KW - Clinical decision support
KW - Diabetes prevention
KW - Electronic medical records
KW - Implementation
KW - Prediabetes
KW - Primary care
KW - Rural health
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U2 - 10.1016/j.cct.2022.106686
DO - 10.1016/j.cct.2022.106686
M3 - Article
C2 - 35091135
AN - SCOPUS:85123824130
SN - 1551-7144
VL - 114
JO - Contemporary Clinical Trials
JF - Contemporary Clinical Trials
M1 - 106686
ER -