journal of biomedical informatics
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Improvements in Diabetic Patients’ Outcomes in a Clinical Decision Support System

Author(s): Sakiko Ota*, Kaoru Mogushi, Aizan Hirai, Yoshihito Niimura and Hiroshi Tanaka

Background: There is considerable interest worldwide in prevention and control of diabetes using health information technology systems. Although previous studies have acknowledged improvements of blood pressure control in a clinical decision support system (CDSS), little is known about whether it could contribute to diabetic patients‘ outcomes.

Objectives: To compare diabetic patients‘ outcomes six months before and after the introduction of a CDSS.

Methods: We considered patients with diabetes in a general hospital and ten clinics that embedded a CDSS within an electronic health record in April 2011, and tracked their medical records from October 2010 to March 2012 (split at April 2011; pre- and post-period). The CDSS mainly had two main functions: (1) to visually highlight abnormal laboratory values on longitudinal inspection data; and (2) to provide a list of patients with severe diabetes. Primary outcome measures included glycated hemoglobin (HbA1c), fasting blood glucose, low-density lipoprotein cholesterol (LDL-C), and glomerular filtration rate (eGFR). The values were averaged for each patient and compared between preand post-period using the Wilcoxon signed-rank test.

Results: A total number of 3,678 blood test results from 705 patients were analyzed. The mean HbA1c levels (and standard deviation) among severe cases (baseline HbA1c ≥ 8.4%) were significantly improved over the study period, from 9.49 ± 1.13% to 8.73 ± 1.23% (p < 0.001). In contrast, the moderate group (baseline HbA1c < 8.4%) deteriorated, from 7.61 ± 0.40% to 7.70 ± 0.65%. In terms of fasting blood glucose levels, the severe group (baseline fasting blood glucose level ≥ 160 mg/dl) improved significantly (p < 0.001). On the contrary, the moderate group (baseline fasting blood glucose level < 160 mg/dl) deteriorated significantly (p < 0.001). The patients’ outcomes were improved with the CDSS.

Conclusion: Improvements of patients‘ outcomes were observed, indicating the potential effectiveness of the CDSS. Visually emphasizing abnormal laboratory values and displaying severe patients may be effective for disease control of diabetes patients.