Implementing electronic health record-based National Diabetes Prevention Program referrals in a rural county

Area of Science:

• Public Health
• Health Informatics
• Diabetes Prevention

Background:

• Collaboration between public health professionals and healthcare organizations in rural Midwest counties since 2016.
• Focus on establishing electronic health record (EHR)-based systems for prediabetes patient identification and referral.
• Initiation of National Diabetes Prevention Program (NDPP) classes for at-risk populations.

Purpose of the Study:

• Evaluate the implementation of an EHR-based prediabetes referral program.
• Identify barriers encountered during program implementation in two rural healthcare organizations.
• Determine best practices for successful program rollout.

Main Methods:

• Purposive sampling of program coordinators, primary care providers, and IT administrators from two rural health organizations.
• Data collection via electronic surveys with open-ended questions.
• Content analysis to identify recurring themes in participant feedback.

Main Results:

• Identified barriers: challenges in timely, clear communication and need for enhanced patient and provider education.
• Identified best practices: starting with a single provider champion, creating resource-efficient referral processes, and ensuring active provider involvement in referral decisions.

Conclusions:

• Retrospective queries are a feasible method for establishing initial EHR-based referral programs in rural settings.
• Public health nurses (PHNs) can drive system changes by fostering partnerships, aligning goals, and facilitating best practice sharing among healthcare organizations.