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Delvaux N, Van Thienen K, Heselmans A, de Velde SV, Ramaekers D, Aertgeerts B. The Effects of Computerized Clinical Decision Support Systems on Laboratory Test Ordering: A Systematic Review. Arch Pathol Lab Med 2017; 141:585-595. [PMID: 28353386 DOI: 10.5858/arpa.2016-0115-ra] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Inappropriate laboratory test ordering has been shown to be as high as 30%. This can have an important impact on quality of care and costs because of downstream consequences such as additional diagnostics, repeat testing, imaging, prescriptions, surgeries, or hospital stays. OBJECTIVE - To evaluate the effect of computerized clinical decision support systems on appropriateness of laboratory test ordering. DATA SOURCES - We used MEDLINE, Embase, CINAHL, MEDLINE In-Process and Other Non-Indexed Citations, Clinicaltrials.gov, Cochrane Library, and Inspec through December 2015. Investigators independently screened articles to identify randomized trials that assessed a computerized clinical decision support system aimed at improving laboratory test ordering by providing patient-specific information, delivered in the form of an on-screen management option, reminder, or suggestion through a computerized physician order entry using a rule-based or algorithm-based system relying on an evidence-based knowledge resource. Investigators extracted data from 30 papers about study design, various study characteristics, study setting, various intervention characteristics, involvement of the software developers in the evaluation of the computerized clinical decision support system, outcome types, and various outcome characteristics. CONCLUSIONS - Because of heterogeneity of systems and settings, pooled estimates of effect could not be made. Data showed that computerized clinical decision support systems had little or no effect on clinical outcomes but some effect on compliance. Computerized clinical decision support systems targeted at laboratory test ordering for multiple conditions appear to be more effective than those targeted at a single condition.
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Affiliation(s)
| | | | | | | | | | - Bert Aertgeerts
- From the Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium (Drs Delvaux, Heselmans, Ramaekers, and Aertgeerts).,the Department of Public Health, Vrije University Brussels, Brussels, Belgium (Dr Van Thienen).,the GUIDES project, Norwegian Institute of Public Health, Oslo, Norway (Dr Van de Velde).,and the Centre for Evidence-Based Medicine (CEBAM), Belgian Branch of the Dutch Cochrane Collaboration, Leuven, Belgium (Drs Ramaekers and Aertgeerts)
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Gammon D, Berntsen GKR, Koricho AT, Sygna K, Ruland C. The chronic care model and technological research and innovation: a scoping review at the crossroads. J Med Internet Res 2015; 17:e25. [PMID: 25677200 PMCID: PMC4342659 DOI: 10.2196/jmir.3547] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/26/2014] [Accepted: 12/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background Information and communication technologies (ICT) are key to optimizing the outcomes of the Chronic Care Model (CCM), currently acknowledged as the best synthesis of available evidence for chronic illness prevention and management. At the same time, CCM can offer a needed framework for increasing the relevance and feasibility of ICT innovation and research in health care. Little is known about how and to what extent CCM and ICT research inform each other to leverage mutual strengths. The current study examines: What characterizes work being done at the crossroads of CCM and ICT research and innovation? Objective Our aim is identify the gaps and potential that lie between the research domains CCM and ICT, thus enabling more substantive questions and opportunities for accelerating improvements in ICT-supported chronic care. Methods Using a scoping study approach, we developed a search strategy applied to medical and technical databases resulting in 1054 titles and abstracts that address CCM and ICT. After iteratively adapting our inclusion/exclusion criteria to balance between breadth and feasibility, 26 publications from 20 studies were found to fulfill our criteria. Following initial coding of each article according to predefined categories (eg, type of article, CCM component, ICT, health issue), a 1st level analysis was conducted resulting in a broad range of categories. These were gradually reduced by constantly comparing them for underlying commonalities and discrepancies. Results None of the studies included were from technical databases and interventions relied mostly on “old-fashioned” technologies. Technologies supporting “productive interactions” were often one-way (provider to patient), and it was sometimes difficult to decipher how CCM was guiding intervention design. In particular, the major focus on ICT to support providers did not appear unique to the challenges of chronic care. Challenges in facilitating CCM components through ICT included poorly designed user interfaces, digital divide issues, and lack of integration with existing infrastructure. Conclusions The CCM is a highly influential guide for health care development, which recognizes the need for alignment of system tools such as ICT. Yet, there seem to be alarmingly few touch points between the subject fields of “health service development” and “ICT-innovation”. Bridging these gaps needs explicit and urgent attention as the synergies between these domains have enormous potential. Policy makers and funding agencies need to facilitate the joining of forces between high-tech innovative expertise and experts in the chronic care system redesign that is required for tackling the current epidemic of long-term multiple conditions.
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Affiliation(s)
- Deede Gammon
- Norwegian Center for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsoe, Norway.
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Towards Personalization of Diabetes Therapy Using Computerized Decision Support and Machine Learning: Some Open Problems and Challenges. SMART HEALTH 2015. [DOI: 10.1007/978-3-319-16226-3_10] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Jeffery R, Iserman E, Haynes RB. Can computerized clinical decision support systems improve diabetes management? A systematic review and meta-analysis. Diabet Med 2013. [PMID: 23199102 DOI: 10.1111/dme.12087] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS To systematically review randomized trials that assessed the effects of computerized clinical decision support systems in ambulatory diabetes management compared with a non-computerized clinical decision support system control. METHODS We included all diabetes trials from a comprehensive computerized clinical decision support system overview completed in January 2010, and searched EMBASE, MEDLINE, INSPEC/COMPENDEX and Evidence-Based Medicine Reviews (EBMR) from January 2010 to April 2012. Reference lists of related reviews, included articles and Clinicaltrials.gov were also searched. Randomized controlled trials of patients with diabetes in ambulatory care settings comparing a computerized clinical decision support system intervention with a non-computerized clinical decision support system control, measuring either a process of care or a patient outcome, were included. Screening of studies, data extraction, risk of bias and quality of evidence assessments were carried out independently by two reviewers, and discrepancies were resolved through consensus or third-party arbitration. Authors were contacted for any missing data. RESULTS Fifteen trials were included (13 from the previous review and two from the current search). Only one study was at low risk of bias, while the others were of moderate to high risk of bias because of methodological limitations. HbA1c (3 months' follow-up), quality of life and hospitalization (12 months' follow-up) were pooled and all favoured the computerized clinical decision support systems over the control, although none were statistically significant. Triglycerides and practitioner performance tended to favour computerized clinical decision support systems although results were too heterogeneous to pool. CONCLUSIONS Computerized clinical decision support systems in diabetes management may marginally improve clinical outcomes, but confidence in the evidence is low because of risk of bias, inconsistency and imprecision.
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Affiliation(s)
- R Jeffery
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Feldstein AC, Schneider JL, Unitan R, Perrin NA, Smith DH, Nichols GA, Lee NL. Health care worker perspectives inform optimization of patient panel-support tools: a qualitative study. Popul Health Manag 2012; 16:107-19. [PMID: 23216061 DOI: 10.1089/pop.2012.0065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Electronic decision-support systems appear to enhance care, but improving both tools and work practices may optimize outcomes. Using qualitative methods, the authors' aim was to evaluate perspectives about using the Patient Panel-Support Tool (PST) to better understand health care workers' attitudes toward, and adoption and use of, a decision-support tool. In-depth interviews were conducted to elicit participant perspectives about the PST-an electronic tool implemented in 2006 at Kaiser Permanente Northwest. The PST identifies "care gaps" and recommendations in screening, medication use, risk-factor control, and immunizations for primary care panel patients. Primary care physician (PCP) teams were already grouped (based on performance pre- and post-PST introduction) into lower, improving, and higher percent-of-care-needs met. Participants were PCPs (n=21), medical assistants (n=11), and quality and other health care managers (n=20); total n=52. Results revealed that the most commonly cited benefit of the PST was increased in-depth knowledge of patient panels, and empowerment of staff to do quality improvement. Barriers to PST use included insufficient time, competing demands, suboptimal staffing, tool navigation, documentation, and data issues. Facilitators were strong team staff roles, leadership/training for tool implementation, and dedicated time for tool use. Higher performing PCPs and their assistants more often described a detailed team approach to using the PST. In conclusion, PCP teams and managers provided important perspectives that could help optimize use of panel-support tools to improve future outcomes. Improvements are needed in tool function and navigation; training; staff accountability and role clarification; and panel management time.
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Affiliation(s)
- Adrianne C Feldstein
- Center for Health Research , Kaiser Permanente Northwest, Portland, Oregon 97227, USA
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Caspersen CJ, Thomas GD, Boseman LA, Beckles GLA, Albright AL. Aging, diabetes, and the public health system in the United States. Am J Public Health 2012; 102:1482-97. [PMID: 22698044 PMCID: PMC3464829 DOI: 10.2105/ajph.2011.300616] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2011] [Indexed: 12/22/2022]
Abstract
Diabetes (diagnosed or undiagnosed) affects 10.9 million US adults aged 65 years and older. Almost 8 in 10 have some form of dysglycemia, according to tests for fasting glucose or hemoglobin A1c. Among this age group, diagnosed diabetes is projected to reach 26.7 million by 2050, or 55% of all diabetes cases. In 2007, older adults accounted for $64.8 billion (56%) of direct diabetes medical costs, $41.1 billion for institutional care alone. Complications, comorbid conditions, and geriatric syndromes affect diabetes care, and medical guidelines for treating older adults with diabetes are limited. Broad public health programs help, but effective, targeted interventions and expanded surveillance and research and better policies are needed to address the rapidly growing diabetes burden among older adults.
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Affiliation(s)
- Carl J Caspersen
- Epidemiology and Statistics Branch, Office of the Director of the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30341-3717, USA.
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Roshanov PS, You JJ, Dhaliwal J, Koff D, Mackay JA, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB. Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review. Implement Sci 2011; 6:88. [PMID: 21824382 PMCID: PMC3174115 DOI: 10.1186/1748-5908-6-88] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 08/03/2011] [Indexed: 11/24/2022] Open
Abstract
Background Underuse and overuse of diagnostic tests have important implications for health outcomes and costs. Decision support technology purports to optimize the use of diagnostic tests in clinical practice. The objective of this review was to assess whether computerized clinical decision support systems (CCDSSs) are effective at improving ordering of tests for diagnosis, monitoring of disease, or monitoring of treatment. The outcome of interest was effect on the diagnostic test-ordering behavior of practitioners. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for eligible articles published up to January 2010. We included randomized controlled trials comparing the use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. Trials were eligible if at least one component of the CCDSS gave suggestions for ordering or performing a diagnostic procedure. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of test ordering outcomes. Results Thirty-five studies were identified, with significantly higher methodological quality in those published after the year 2000 (p = 0.002). Thirty-three trials reported evaluable data on diagnostic test ordering, and 55% (18/33) of CCDSSs improved testing behavior overall, including 83% (5/6) for diagnosis, 63% (5/8) for treatment monitoring, 35% (6/17) for disease monitoring, and 100% (3/3) for other purposes. Four of the systems explicitly attempted to reduce test ordering rates and all succeeded. Factors of particular interest to decision makers include costs, user satisfaction, and impact on workflow but were rarely investigated or reported. Conclusions Some CCDSSs can modify practitioner test-ordering behavior. To better inform development and implementation efforts, studies should describe in more detail potentially important factors such as system design, user interface, local context, implementation strategy, and evaluate impact on user satisfaction and workflow, costs, and unintended consequences.
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Affiliation(s)
- Pavel S Roshanov
- Health Research Methodology Program, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
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Roshanov PS, Misra S, Gerstein HC, Garg AX, Sebaldt RJ, Mackay JA, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB. Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review. Implement Sci 2011; 6:92. [PMID: 21824386 PMCID: PMC3170626 DOI: 10.1186/1748-5908-6-92] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 08/03/2011] [Indexed: 11/13/2022] Open
Abstract
Background The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Results Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. Conclusions A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.
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Affiliation(s)
- Pavel S Roshanov
- Health Research Methodology Program, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
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Khan S, Maclean CD, Littenberg B. The effect of the Vermont Diabetes Information System on inpatient and emergency room use: results from a randomized trial. ACTA ACUST UNITED AC 2010; 1:e61-e66. [PMID: 20975923 DOI: 10.1016/j.ehrm.2010.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE: To describe the effect of the Vermont Diabetes Information System (VDIS) on hospital and emergency room use DATA SOURCE: Statewide discharge database STUDY DESIGN: Randomized controlled trial of a decision support system for 7,412 adults with diabetes and their 64 primary care providers. DATA COLLECTION/ DATA EXTRACTION: Charges and dates for hospital admissions and emergency room care in Vermont during an average of 32 months of observation. Data from New York hospitals were not available. PRINCIPAL FINDINGS: Patients randomized to VDIS were admitted to the hospital less often than control subjects (0.17 admissions vs. 0.20; P=0.01) and generated lower hospital charges ($3,113 vs. $3,480; P=0.019). VDIS patients also had lower emergency room utilization (0.27 visits vs. 0.36; P<0.0001) and charges ($304 vs. $414; P<0.0001). The intervention was particularly effective in men and in older subjects. CONCLUSIONS: In spite of data limitations that tended to reduce the apparent effect of the system; this randomized, controlled trial showed that VDIS reduces hospitalization and emergency room utilization and expenses.
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Affiliation(s)
- Shamima Khan
- Pharmacy and Administrative Sciences, College of Pharmacy and Allied Health Professions, St. Albert's Hall, Room 108, St. John's University, Jamaica, NY, , ,
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Maclean CD, Gagnon M, Callas P, Littenberg B. The Vermont diabetes information system: a cluster randomized trial of a population based decision support system. J Gen Intern Med 2009; 24:1303-10. [PMID: 19862578 PMCID: PMC2787948 DOI: 10.1007/s11606-009-1147-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 07/16/2009] [Accepted: 09/24/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Optimal care for patients with diabetes is difficult to achieve in clinical practice. OBJECTIVE To evaluate the impact of a registry and decision support system on processes of care, and physiologic control. PARTICIPANTS Randomized trial with clustering at the practice level, involving 7,412 adults with diabetes in 64 primary care practices in the Northeast. INTERVENTIONS Provider decision support (reminders for overdue diabetes tests, alerts regarding abnormal results, and quarterly population reports with peer comparisons) and patient decision support (reminders and alerts). MEASUREMENTS AND MAIN RESULTS Process and physiologic outcomes were evaluated in all subjects. Functional status was evaluated in a random patient sample via questionnaire. We used multiple logistic regression to quantify the effect, adjusting for clustering and potential confounders. Intervention subjects were significantly more likely to receive guideline-appropriate testing for cholesterol (OR = 1.39; [95%CI 1.07, 1.80] P = 0.012), creatinine (OR = 1.40; [95%CI 1.06, 1.84] P = 0.018), and proteinuria (OR = 1.74; [95%CI 1.13, 1.69] P = 0.012), but not A1C (OR = 1.17; [95% CI 0.80, 1.72] P = 0.43). Rates of control of A1C and LDL cholesterol were similar in the two groups. There were no differences in blood pressure, body mass index, or functional status. CONCLUSIONS A chronic disease registry and decision support system based on easily obtainable laboratory data was feasible and acceptable to patients and providers. This system improved the process of laboratory monitoring in primary care, but not physiologic control.
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Affiliation(s)
- Charles D Maclean
- Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl Street, Burlington, VT 05401, USA.
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Chamany S, Silver LD, Bassett MT, Driver CR, Berger DK, Neuhaus CE, Kumar N, Frieden TR. Tracking diabetes: New York City's A1C Registry. Milbank Q 2009; 87:547-70. [PMID: 19751279 PMCID: PMC2881457 DOI: 10.1111/j.1468-0009.2009.00568.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
CONTEXT In December 2005, in characterizing diabetes as an epidemic, the New York City Board of Health mandated the laboratory reporting of hemoglobin A1C laboratory test results. This mandate established the United States' first population-based registry to track the level of blood sugar control in people with diabetes. But mandatory A1C reporting has provoked debate regarding the role of public health agencies in the control of noncommunicable diseases and, more specifically, both privacy and the doctor-patient relationship. METHODS This article reviews the rationale for adopting the rule requiring the reporting of A1C test results, experience with its implementation, and criticisms raised in the context of the history of public health practice. FINDINGS For many decades, public health agencies have used identifiable information collected through mandatory laboratory reporting to monitor the population's health and develop programs for the control of communicable and noncommunicable diseases. The registry program sends quarterly patient rosters stratified by A1C level to more than one thousand medical providers, and it also sends letters, on the provider's letterhead whenever possible, to patients at risk of diabetes complications (A1C level >9 percent), advising medical follow-up. The activities of the registry program are similar to those of programs for other reportable conditions and constitute a joint effort between a governmental public health agency and medical providers to improve patients' health outcomes. CONCLUSIONS Mandatory reporting has proven successful in helping combat other major epidemics. New York City's A1C Registry activities combine both traditional and novel public health approaches to reduce the burden of an epidemic chronic disease, diabetes. Despite criticism that mandatory reporting compromises individuals' right to privacy without clear benefit, the early feedback has been positive and suggests that the benefits will outweigh the potential harms. Further evaluation will provide additional information that other local health jurisdictions may use in designing their strategies to address chronic disease.
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Affiliation(s)
- Shadi Chamany
- New York City Department of Health and Mental Hygiene, NY, USA.
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Mello MM, Gostin LO. Commentary: A legal perspective on diabetes surveillance--privacy and the police power. Milbank Q 2009; 87:575-80. [PMID: 19751281 DOI: 10.1111/j.1468-0009.2009.00570.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Michelle M Mello
- Department of Health Policy and Administration, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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Abstract
Disease registries are a searchable list of all patients with a particular chronic condition that often interface with an electronic medical record. The well-designed registry links all members of the patient's health team and provides key information for patients and physicians. The critical impact of a registry is that it can allow timely identification of high-risk subpopulations permitting the health care team to intensify treatment. Diabetes is a data-driven disease that lends itself well to registry use. This review will examine some current registry uses and highlight some of the respective challenges and benefits. This review compares key examples of registries in different health settings. These include a municipal registry (New York City), academic health centers (Penn State Milton S. Hershey Medical Center), third-party payers (Kaiser Permanente), the Veterans Affairs Health System, and international registries (the DIABCARE Q-NET in Europe and the National Diabetes Surveillance System in Canada). Different aspects are compared and contrasted such as the institutional plan for each and whether care in the "here and now" is impacted.
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Affiliation(s)
- Leila Khan
- Penn State Institute for Diabetes and Obesity, Pennsylvania State University College of Medicine , Hershey, Pennsylvania 17033, USA.
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Kemple AM, Hartwick N, Sitaker MH, Harmon JJ, Norman J, Clark K. Exploring the feasibility of combining chronic disease patient registry data to monitor the status of diabetes care. Prev Chronic Dis 2008; 5:A124. [PMID: 18793512 PMCID: PMC2578765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION To provide direction and to support improvements in diabetes care, states must be able to measure the effectiveness of interventions and gain feedback on progress. We wanted to know if data from multiple health clinics that are implementing quality improvement strategies could be combined to provide useful measurements of diabetes care processes and control of intermediate outcomes. METHODS We combined and analyzed electronic patient health data from clinic sites across Washington State that used the Chronic Disease Electronic Management System (CDEMS) registry. The data were used to determine whether national and state objectives for diabetes care were met. We calculated the percentage of patients that met standards of care in 2004. RESULTS The pooled dataset included 17,349 adult patients with diabetes from 90 clinics. More than half of patients were above recommended target levels for hemoglobin A1c testing, foot examination, hemoglobin A1c control, and low-density lipoprotein cholesterol control. Fewer patients met recommendations for nephropathy assessment, eye examinations, and blood pressure control. In terms of meeting these standards, rates of diabetes care varied across clinics. CDEMS rates of care were compared with those reported by other data sources, but no consistent pattern of similarities or differences emerged. CONCLUSION With committed staff time, provider support, and resources, data from clinical information systems like CDEMS can be combined to address a deficiency in state-level diabetes surveillance and evaluation systems--specifically, the inability to capture clinical biometric values to measure intermediate health outcomes. These data can complement other surveillance and evaluation data sources to help provide a better picture of diabetes care in a state.
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Affiliation(s)
- Angela M Kemple
- Chronic Disease Prevention Unit, Washington State Department of Health
| | - Noelle Hartwick
- Chronic Disease Prevention Unit, Diabetes Prevention and Control Program, Washington State Department of Health, Olympia, Washington
| | - Marilyn H Sitaker
- Chronic Disease Prevention Unit, Diabetes Prevention and Control Program, Washington State Department of Health, Olympia, Washington
| | - Jeanne J Harmon
- Chronic Disease Prevention Unit, Diabetes Prevention and Control Program, Washington State Department of Health, Olympia, Washington
| | - Jan Norman
- Chronic Disease Prevention Unit, Diabetes Prevention and Control Program, Washington State Department of Health, Olympia, Washington
| | - Kathleen Clark
- Health Care Authority, Olympia, Washington. At the time of this project, Ms Clark was manager of the Washington State Diabetes Prevention and Control Program
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Goldman J, Kinnear S, Chung J, Rothman DJ. New York City's initiatives on diabetes and HIV/AIDS: implications for patient care, public health, and medical professionalism. Am J Public Health 2008; 98:807-13. [PMID: 18381989 DOI: 10.2105/ajph.2007.121152] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Two recent New York City Department of Health and Mental Hygiene initiatives expanded the mission and scope of public health, with implications for both New York and the nation. The programs target diabetes and HIV/AIDS for greater systemic and expanded reporting, surveillance, and intervention. These initiatives do not balance heightened surveillance and intervention with the provision of meaningful safeguards or resources for prevention and treatment. The programs intrude on the doctor-patient relationship and may alienate the very patients and health professionals they aim to serve. Better models are available to achieve their intended goals. These initiatives should be reconsidered so that such an expansion of public health authority in New York City does not become part of a national trend.
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Affiliation(s)
- Janlori Goldman
- Center on Medicine as a Profession, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, P&S Box 11, New York, NY 10032, USA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the current state of diabetes in the United States and to explore novel, population-based approaches that involve the patient, provider and community, in the context of the health system, to improve diabetes care. RECENT FINDINGS Currently, there is sub-optimal delivery of diabetes processes and outcomes in the United States. The US healthcare system remains rooted in acute and episodic care, resulting in consistently low-quality healthcare, and is not equipped to handle the diabetes epidemic. Evidence demonstrates that models of chronic care are needed in order for system changes to occur. Recent studies that have implemented such models are beginning to demonstrate improvements in both process measures and clinical outcomes following interventions which incorporate a comprehensive approach to chronic illness care. SUMMARY Research over the past 5+ years demonstrates that a more comprehensive approach to diabetes care is needed. Only recently have studies been able to validate this concept, however. Applied research that strives to translate available knowledge and operationalize it in clinical and public health practice is needed in order for diabetes care to improve.
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Affiliation(s)
- Gretchen A Piatt
- University of Pittsburgh Diabetes Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2007; 14:170-96. [PMID: 17940437 DOI: 10.1097/med.0b013e3280d5f7e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Joshy G, Simmons D. Diabetes information systems: a rapidly emerging support for diabetes surveillance and care. Diabetes Technol Ther 2006; 8:587-97. [PMID: 17037973 DOI: 10.1089/dia.2006.8.587] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND With the rapid advances in information technology in the last decade, various diabetes information systems have evolved in different parts of the world. Availability of new technologies and information systems for monitoring and treating diabetes is critical to achieving recommended metabolic control, including glycosylated hemoglobin levels. The first step is to develop a registry, including a patient identifier that can link multiple data sources, which can then serve as a springboard to electronic mechanisms for practitioners to gain information on performance and results. OBJECTIVE The aim is to review the provisions for diabetes surveillance in different parts of the world. This is a systematic review of national and regional information systems for diabetes surveillance. LITERATURE REVIEW A comprehensive review was undertaken using Medline literature review, internet search using the Google search engine, and e-mail consultation with opinion leaders. TOPICS REVIEW: National/regional-level diabetes surveillance systems in Europe, the United States, Australia/New Zealand, and Asia have been reviewed. State-of-the-art diabetes information systems linking multiple data sources, with extensive audit and feedback capabilities, have also been looked at. RESULTS National/regional-level audit databases have been tabulated. Diabetes information systems linking multiple data sources have been described. Most of the developed countries have now implemented systems such as diabetes registers and audits for diabetes surveillance in at least some regions, if not nationally. Developing nations are beginning to recognize the need for chronic disease management. CONCLUSIONS With the advancements in information technology, the diabetes registers have the potential to rise beyond their traditional functions with dynamic data integration, decision support, and data access, as demonstrated by some diabetes information systems. With the rapid pace of development in electronic health records and health information systems, countries that are beginning to build their health information technology infrastructure could benefit from planning and funding along these lines.
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Affiliation(s)
- Grace Joshy
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
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