journal of biomedical informatics
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Impact of the Use of an Electronic Template on Clinicians Adherence to Follow Guidelines for Diabetes Care

Author(s): Vishal Mundra, Shadi Yaghoubian, Viet Nguyen, Darby Sider, Jose Muniz, Carmen V Villabona

Introduction: Diabetes mellitus (DM) was the seventh leading cause of death in 2006. The number of patients is expected to double by 2050. Simple non-adherence to follow guidelines by physicians is a significant source of morbidity and mortality. Our goal was to study the impact of an electronic template on adherence to follow ADA guidelines for diabetes care by general internist.

Methods: We designed an electronic template based on the 8 point ADA guidelines for management of diabetes type 2 including: glycosylated hemoglobin (HgbA1c) assessment, blood pressure (BP), lipid control, smoking cessation counseling, diabetic foot exams, pneumococcal vaccination (PCV), renal assessment and annual retina exam.A randomly selected pre-intervention control group was compared after 6 months of template use to a randomly selected post-intervention group independent of age and sex variables. Same patients were not followed in the control and intervention group.

Results: Our intervention group consisted of 212 subjects, they were compared with a control group of 154. Significant improvements were detected in HbA1c testing (57.5% vs. 94.1%; p<0.001), BP control/intervention done (53.3% vs. 89.1%; p<0.001), low-density lipoprotein (LDL) control/intervention done (65.6% vs. 90.0%; p<0.001), compliance with diabetic foot exams (88.3% vs. 99.1%; p 0.001), compliance with annual eye exams (38.3% vs. 94.8%; p<0.001). Non-significant improvements were detected in smoking cessation counseling (97.3% vs 100%; p 0.578), renal assessment (92.8% to 92.9%; p 0.72). No pre intervention data on PCV was available, so no comparisons were done.

Conclusion: Utilization of a template in the EMR showed a significant improvement in diabetes care including HbA1c assessment, BP control, LDL control, foot examination, and annual eye examination. Use of templates in the EMR system showed increased adherence to guidelines by physicians, this might extrapolate to other chronic diseases.