Implementing a prediabetes clinical decision support system in a large primary care system: Design, methods, and...

Area of Science:

• Cardiology
• Primary Care Medicine
• Health Informatics

Background:

• Early detection and management of prediabetes are crucial for preventing cardiovascular disease.
• Clinicians often face delays in addressing cardiovascular risk factors in prediabetes patients.
• Clinical Decision Support (CDS) systems offer a potential solution for improving prediabetes identification and treatment.

Purpose of the Study:

• To evaluate the effectiveness of a prediabetes Clinical Decision Support (CDS) tool in primary care settings.
• To assess the impact of the CDS tool on cardiovascular risk factor management in patients with prediabetes.
• To examine the implementation processes and outcomes of the CDS tool in a real-world clinical environment.

Main Methods:

• A cluster-randomized pragmatic trial involving 34 Midwestern primary care clinics.
• Randomization of clinics to receive or not receive access to a prediabetes CDS tool.
• Primary care clinicians (PCPs) received CDS alerts for adult patients with prediabetes and uncontrolled cardiovascular risk factors.
• Outcomes measured included total modifiable cardiovascular risk, individual risk factors, medication use, and referrals.
• Implementation processes were examined using the Consolidated Framework for Implementation Research, interviews, surveys, and electronic health record data.

Main Results:

• Analyses are ongoing, with trial results anticipated in mid-2021.
• The study design allows for an intent-to-treat analysis to assess effectiveness.
• Pre-implementation activities focused on strategies to ensure tool acceptability and high usage rates.

Conclusions:

• The cluster-randomized trial provides an opportunity for PCPs to proactively manage cardiovascular risk in prediabetes patients.
• The study will yield insights into the effectiveness and implementation of CDS tools for prediabetes management.
• Findings are expected to inform future strategies for integrating CDS into primary care to improve cardiovascular outcomes.