Bowen Michael E, Merchant Zahra, Abdullah Kazeen, Bhat Deepa, Fish Jason, Halm Ethan A
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Health Serv Res Manag Epidemiol. 2017 Aug 29;4:2333392817721647. doi: 10.1177/2333392817721647. eCollection 2017 Jan-Dec.
Although elevated glucose values are strongly associated with undiagnosed diabetes, they are frequently overlooked. Patient, provider, and system factors associated with failure to follow-up elevated glucose values in electronic medical records (EMRs) are not well described.
We conducted a chart review in a comprehensive EMR with a patient portal and results management features. Established primary care patients with no known diagnosis of diabetes and ≥ 1 glucose value >125 mg/dL were included. Follow-up failure was defined as (1) no documented comment on the glucose value or result communication to the patient within 30 days or (2) no hemoglobin A (HbA) ordered within 30 days or resulted within 12 months. Associations were examined using Wilcoxon and χ tests.
Of 150 charts reviewed, 97 met inclusion criteria. The median glucose was 133 mg/dL, and 20% of patients had multiple values >125 mg/dL. Only 36% of elevated glucose values were followed up. No associations were observed between patient characteristics, diabetes risk factors, or provider characteristics and follow-up failures. Automated flagging of glucose values ≥140 mg/dL by highlighting them red in the EMR was not associated with improved follow-up (46% vs 32%; = .19). Even when follow-up occurred (n = 35), only 31% completed gold standard diabetes testing (HbA) within 12 months. Of the resulted HbA tests (n = 11), 55% were in the prediabetes range (5.7%-6.4%).
Two-thirds of elevated glucose values were not followed up, despite EMR features facilitating results management. Greater understanding of the results management process and improved EMR functionalities to support results management are needed.
尽管血糖值升高与未确诊的糖尿病密切相关，但它们经常被忽视。电子病历（EMR）中与未能对升高的血糖值进行随访相关的患者、医护人员和系统因素尚未得到充分描述。
我们在一个具有患者门户和结果管理功能的综合电子病历系统中进行了图表审查。纳入了已确诊的初级保健患者，这些患者无糖尿病诊断且血糖值≥125mg/dL。随访失败定义为：（1）30天内未对血糖值进行记录注释或未与患者进行结果沟通；或（2）30天内未开具血红蛋白A（HbA）检测医嘱或12个月内未得出检测结果。使用Wilcoxon检验和χ检验进行相关性分析。
在审查的150份图表中，97份符合纳入标准。血糖中位数为133mg/dL，20%的患者有多个值>125mg/dL。仅36%的血糖值升高得到了随访。未观察到患者特征、糖尿病风险因素或医护人员特征与随访失败之间存在相关性。在电子病历中通过将血糖值≥140mg/dL标记为红色进行自动标记，与随访改善无关（46%对32%；P = 0.19）。即使进行了随访（n = 35），也只有31%的患者在12个月内完成了糖尿病金标准检测（HbA）。在得出结果的HbA检测中（n = 11），55%处于糖尿病前期范围（5.7%-6.4%）。
尽管电子病历具有便于结果管理的功能，但三分之二的血糖值升高未得到随访。需要更深入了解结果管理流程并改进电子病历功能以支持结果管理。
