Trial of Decision Support to Improve Diabetes Outcomes

改善糖尿病结局的决策支持试验

• 批准号: 6949560
• 负责人: RANDALL D CEBUL
• 金额: $ 50万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6949560
• 关键词: Internet; automated medical record system; behavioral /social science research tag; blood chemistry; clinical research; clinical trials; comorbidity; computer assisted medical decision making; diabetes mellitus therapy; health behavior; health care personnel performance; health care quality; health care service evaluation; health care service utilization; health services research tag; human data; human subject; low socioeconomic status; patient care management; patient oriented research; patient safety /medical error; questionnaires; racial /ethnic difference; satisfaction; therapy adverse effect

DESCRIPTION: (PROVIDED BY APPLICANT): Diabetes is an independent risk factor for the nation's first and third leading killers and the leading cause of kidney failure and adult blindness. Evidence-based guidelines exist for control of glycemia (A1c levels), lipid abnormalities (LDL levels), hypertension (HBP), kidney and eye disease, yet gaps exist between what can be achieved and current performance. Competing approaches to improvement include disease management and patient empowerment, both of which can be facilitated by electronic medical records (EMR)-centered decision support. Aims and Methods: The investigation is a 2-year cluster-randomized trial of 22 primary cafe practices, 197 PCPs, and their 13,000 adult diabetics across two health systems experienced in using the same commercial EMR system. Four clusters of similar practices will be assigned randomly to EMR-based disease management (EMR-DM 2). web portal-based patient empowerment (EMR-PE), both approaches (EMR-Both). or EMR alone. Our Aims are to: 1) compare the incremental effects of our interventions on primary outcomes (quality of care/patient safety, and utilization), adjusting as necessary for baseline prognostic differences, adjusting for clustering and using an intention-to-treat analysis; 2) estimate intervention effects in pre-specified sub-groups: 3) describe specific features of patients and PCPs that are associated with different types and levels of adoption of our interventions; and 4) describe general and intervention-specific unintended consequences of our interventions. Significance: The results of this investigation will be of critical value to providers and their patients with chronic illnesses, to payers and insurers, to policymakers, and to those seeking to better understand EMR-based decision support - its adoption, and its usefulness for improving quality and safety in patient care. CCF Partnership: CCF investigators Harris, Miller, and Jain will collaborate on all aspects of this project. CCF will lead the components of the study related to patient empowerment utilizing the MyChart clinical application currently being deployed at CCF.

描述：（由申请人提供）：糖尿病是该国第一和第三主杀手的独立风险因素，也是肾衰竭和成人失明的主要原因。存在基于证据的指南，以控制血糖（A1C水平），脂质异常（LDL水平），高血压（HBP），肾脏和眼病，但在可以实现的目标与当前表现之间存在差距。竞争改进的方法包括疾病管理和赋予患者权能，这两者都可以通过以电子病历（EMR）为中心的决策支持来促进。 目的和方法：调查是一项为期2年的集群随机试验，对22种主要咖啡馆实践，197个PCP，以及在使用同一商业EMR系统方面经历的两个卫生系统中的13,000个成人糖尿病患者。四个类似实践的簇将被随机分配给基于EMR的疾病管理（EMR-DM 2）。基于Web门户网站的患者授权（EMR-PE），两种方法（EMR-BOTH）。或单独使用EMR。我们的目的是：1）比较我们的干预措施对主要结果（护理/患者安全质量和利用率）的增量影响，以根据基线预后差异的必要条件进行调整，以调整聚类和使用意向性治疗分析； 2）估计预先指定子组的干预效果：3）描述与我们的干预措施不同类型和采用水平相关的患者和PCP的特定特征； 4）描述我们的干预措施的一般和干预特定意想不到的后果。 意义：这项调查的结果对提供者及其慢性病，付款人和保险公司，政策制定者以及寻求更好地理解基于EMR的决策支持的人至关重要。 CCF合作伙伴关系：CCF调查人员Harris，Miller和Jain将在该项目的各个方面合作。 CCF将利用目前正在CCF部署的MYCHART临床应用程序来领导与赋予患者赋权有关的研究组成部分。