AIMS: We retrospectively compared glycemic control and glycemic burden in type 2 diabetes patients treated by general physicians with access to decision support with those treated by general physicians without access to decision support. METHODS: A total of 875 patients [471 (53.8%) males] aged 54.3 [standard deviation (SD) 13.1] years followed up over 84 months. A total of 342 patients (39%) were managed with decision support, and effects on glycosylated hemoglobin (HbA1c) were assessed. RESULTS: There was no difference between groups in starting HbA1c [7.6 (SD 1.8) versus 7.5 (SD 1.5); p = not significant] at baseline. Patients treated with decision support were more likely to have planned review of HbA1c, adjustment of medication, prescription of statins, dietetic and nurse educator inputs (71.3% versus 58.5%; Chi squared = 14.7; p = .001). The mean HbA1c in the group treated with decision support was not significantly reduced within the first year [7.5% (SD 1.8) versus 7.6% (SD 1.5); p = not significant; 95% confidence interval (CI) -0.33 to 0.17], but statistically significant differences were apparent at year 2 [7.2% (SD 2.0) versus 8% (SD 3.4); p = .0001; 95% CI -1.3 to -0.5] and sustained through year 3 [7.2% (SD 2.0) versus 8.0% (SD 2.0); p = .0001; 95% CI -1.2 to -0.6], year 4 [7.2% (SD 2.3) versus 8.2% (SD 2.5); p = .0001; 95% CI -1.2 to -0.6], year 5 [7.0% (SD 2.3) versus 8.3% (SD 2.6); p = .001; 95% CI -1.5 to -0.8], year 6 [7.0% (SD 2.0) versus 8.2% (SD 2.4); p = .001; 95% CI -1.5 to -0.9], and year 7 [6.9% (SD 1.2) versus 8% (SD 1.8); p = .001; 95% CI -1.4 to -1.0]. CONCLUSION: Use of a decision support system showed benefits in adherence to clinical care pathways and achieving significant improvements in glycemic control.
AIMS: We retrospectively compared glycemic control and glycemic burden in type 2 diabetespatients treated by general physicians with access to decision support with those treated by general physicians without access to decision support. METHODS: A total of 875 patients [471 (53.8%) males] aged 54.3 [standard deviation (SD) 13.1] years followed up over 84 months. A total of 342 patients (39%) were managed with decision support, and effects on glycosylated hemoglobin (HbA1c) were assessed. RESULTS: There was no difference between groups in starting HbA1c [7.6 (SD 1.8) versus 7.5 (SD 1.5); p = not significant] at baseline. Patients treated with decision support were more likely to have planned review of HbA1c, adjustment of medication, prescription of statins, dietetic and nurse educator inputs (71.3% versus 58.5%; Chi squared = 14.7; p = .001). The mean HbA1c in the group treated with decision support was not significantly reduced within the first year [7.5% (SD 1.8) versus 7.6% (SD 1.5); p = not significant; 95% confidence interval (CI) -0.33 to 0.17], but statistically significant differences were apparent at year 2 [7.2% (SD 2.0) versus 8% (SD 3.4); p = .0001; 95% CI -1.3 to -0.5] and sustained through year 3 [7.2% (SD 2.0) versus 8.0% (SD 2.0); p = .0001; 95% CI -1.2 to -0.6], year 4 [7.2% (SD 2.3) versus 8.2% (SD 2.5); p = .0001; 95% CI -1.2 to -0.6], year 5 [7.0% (SD 2.3) versus 8.3% (SD 2.6); p = .001; 95% CI -1.5 to -0.8], year 6 [7.0% (SD 2.0) versus 8.2% (SD 2.4); p = .001; 95% CI -1.5 to -0.9], and year 7 [6.9% (SD 1.2) versus 8% (SD 1.8); p = .001; 95% CI -1.4 to -1.0]. CONCLUSION: Use of a decision support system showed benefits in adherence to clinical care pathways and achieving significant improvements in glycemic control.
Authors: Richard Grant; Alyce S Adams; Connie Mah Trinacty; Fang Zhang; Ken Kleinman; Stephen B Soumerai; James B Meigs; Dennis Ross-Degnan Journal: Diabetes Care Date: 2007-01-26 Impact factor: 19.112
Authors: Lawrence S Phillips; David C Ziemer; Joyce P Doyle; Catherine S Barnes; Paul Kolm; William T Branch; Jane M Caudle; Curtiss B Cook; Virginia G Dunbar; Imad M El-Kebbi; Daniel L Gallina; Risa P Hayes; Christopher D Miller; Mary K Rhee; Dennis M Thompson; Clyde Watkins Journal: Diabetes Care Date: 2005-10 Impact factor: 19.112
Authors: Paul C Hicks; John M Westfall; Rebecca F Van Vorst; Caroline Bublitz Emsermann; L Miriam Dickinson; Wilson Pace; Bennett Parnes Journal: Diabetes Care Date: 2006-12 Impact factor: 19.112
Authors: Rury R Holman; Sanjoy K Paul; M Angelyn Bethel; David R Matthews; H Andrew W Neil Journal: N Engl J Med Date: 2008-09-10 Impact factor: 91.245
Authors: Prasad R Padala; Cyrus V Desouza; Stephanie Almeida; Vijay Shivaswamy; Krishan Ariyarathna; Lance Rouse; William J Burke; Frederick Petty Journal: Diabetes Res Clin Pract Date: 2007-08-06 Impact factor: 5.602
Authors: Julie A Schmittdiel; Connie S Uratsu; Andrew J Karter; Michele Heisler; Usha Subramanian; Carol M Mangione; Joe V Selby Journal: J Gen Intern Med Date: 2008-03-04 Impact factor: 5.128