Context: Medical groups have invested billions of dollars in outpatient Electronic Medical Records (EMR), but few studies demonstrate a positive impact of EMR-based clinical decision support on clinically important patient outcomes.
Objectives: To assess the impact 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.
Design, Setting, and Participants: The study 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.
Main Outcome Measures: Post-intervention levels of A1c, BP, and LDL controlling for pre-intervention levels.
Results: Intervention group PCPs used the EMR-based decision support system at over 62.6% of all diabetes patient visits, and intensified drug therapy at 61.9%, 43.6% and 18.8% of visits with uncontrolled A1c, BP, and lipids, respectively. Intervention group diabetes patients had significantly better A1c (p=.014) and SBP (p=.035) but not LDL (p=.63) relative to patients of PCPs randomized to the control arm of the study based on general linear mixed models with a repeated time measurement to control for clustering. Additional analytic models that adjusted for patient age, gender, and comorbidity showed similar results. Ninety-four percent of PCPs expressed satisfaction with the intervention, and moderate rates of use persisted for over a year after withdrawal of feedback and incentives to encourage use.
Conclusions: An EMR-based diabetes clinical decision support significantly improved glucose control and BP control in adults with type 2 diabetes who were not at recommended clinical goals.
