Background and Aims : Medical groups have invested billions of dollars in outpatient Electronic Medical Records (EMR), but few studies demonstrate the cost-effectiveness of EMR-based clinical decision support. The aim of this study was to assess the cost-effectiveness of an EMR-based diabetes clinical decision support system on control of glycated hemoglobin (A1c), blood pressure (BP) and LDL-Cholesterol (LDL) in adults with diabetes based on results from a randomized clinical trial (RCT).
Methods : The RCT was conducted from October 2006 to May 2007 in Minnesota. Eleven clinics with 41 consenting primary care physicians (PCP) and these physicians鈥� 2556 diabetes patients were randomized either to receive or not to receive an EMR-based clinical decision support system designed to improve A1c, BP, and LDL in diabetes patients not at recommended clinical goals at the time of an office visit. A diabetes simulation model was used to estimate costs and quality of life years (QALYs) gained over a 40 year period from the health plan perspective.
Results : Intervention group PCPs used the EMR-based decision support system at 63% of all diabetes patient visits, and intensified drug therapy at 62% of visits with uncontrolled A1c. Intervention group diabetes patients had significantly lowered A1c (0.26%, p=.014) relative to patients of PCPs randomized to the control arm. The EMR-based decision support had a positive net cost of $280 (SE=207) in the first year. The cost per QALY was $22,000 over a 40-year period.
Conclusions : An EMR-based diabetes clinical decision support is a cost-effective approach to improve glucose control in adults with type 2 diabetes who were not at recommended clinical goals.
