Zhang Xiaoni, Svec Michelle, Tracy Robert, Ozanich Gary
Department of Business Informatics, Northern Kentucky University, Highland Heights, KY 41099, United States.
St. Elizabeth Healthcare, 1 Medical Village Dr., Edgewood, KY 41017, United States.
Int J Med Inform. 2021 Nov 18;158:104626. doi: 10.1016/j.ijmedinf.2021.104626.
The prevalence of clinical inertia, the failure of appropriate treatment intensification in diabetes treatment, is a well-documented worldwide phenomenon. This project addresses the problem of clinical inertia through three interrelated activities, clinical decision support (CDSS), team-based care, and patient engagement in diabetes management.
The purpose of this research is to provide analysis under the State-University Partnership Learning Network regarding the impact of an electronic decision support tool combined with team-based care workflow on provider decision-making and patient outcomes for the treatment of poorly controlled diabetes mellitus (diabetes) among patients receiving Kentucky Medicaid. The objectives of this study are to 1) assess clinical outcomes of type 2 diabetes in the Medicaid population with team-based care using CDSS, 2) evaluate physicians' and pharmacists' experience on CDSS.
This is a quality improvement project using a mixed-method - longitudinal and control group comparison of outcomes based upon clinical measures and online surveys of providers and pharmacists involved in this project.
Patients treated by providers who changed the treatment regimen to one that either fully or partially followed the recommendation of the CDSS tool had a statistically significant reduction in HbA1c with an average initial HbA1c of 10.1 and the final HbA1c of 8. The online survey of physicians shows that more than 80% of physicians agree the use of CDSS will support improved patient outcomes. The use of a team-based care approach that includes pharmacists in implementing treatment changes was broadly supported by both physicians and pharmacists.
CDSS combined with team-based care can be effective in reducing HbA1c to targeted therapeutic levels. The use of CDSS provides a way to efficiently assess more than 160 potential frontline drugs and properly accelerate treatment. Consistent with the research literature, the inclusion of pharmacists can play a key role in team-based care to assess treatment alternatives and provide for improvement in outcomes and patient adherence for diabetes. The user surveys show both physicians and pharmacists have a positive attitude toward CDSS.
临床惰性，即在糖尿病治疗中未能适当加强治疗，是一种在全球范围内有充分记录的现象。该项目通过三项相互关联的活动来解决临床惰性问题，即临床决策支持（CDSS）、团队式护理以及患者参与糖尿病管理。
本研究的目的是在州立大学合作学习网络下，分析电子决策支持工具与团队式护理工作流程相结合对接受肯塔基医疗补助的患者中控制不佳的糖尿病（糖尿病）治疗的提供者决策和患者结局的影响。本研究的目标是：1）使用CDSS评估基于团队护理的医疗补助人群中2型糖尿病的临床结局；2）评估医生和药剂师对CDSS的体验。
这是一个质量改进项目，采用混合方法——基于临床指标的纵向和对照组结局比较，以及对参与该项目的提供者和药剂师进行在线调查。
由将治疗方案改为完全或部分遵循CDSS工具建议的提供者治疗的患者，糖化血红蛋白（HbA1c）有统计学显著降低，初始平均HbA1c为10.1，最终HbA1c为8。医生的在线调查显示，超过80%的医生同意使用CDSS将有助于改善患者结局。医生和药剂师广泛支持采用包括药剂师在内的团队式护理方法来实施治疗变更。
CDSS与团队式护理相结合可有效将HbA1c降低至目标治疗水平。使用CDSS提供了一种有效评估160多种潜在一线药物并适当加速治疗的方法。与研究文献一致，药剂师的参与在团队式护理中可发挥关键作用，以评估治疗方案并改善糖尿病的结局和患者依从性。用户调查显示医生和药剂师对CDSS都持积极态度。
