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Addressing Therapeutic Inertia: Development and Implementation of an Electronic Health Record-Based Diabetes

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Low use of an electronic health record (EHR) tool for diabetes management did not improve A1C goals. This highlights therapeutic inertia, indicating a need for better strategies to integrate and utilize EHR tools in clinical practice.

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Area of Science:

  • Diabetes Management
  • Health Informatics
  • Clinical Practice Improvement

Background:

  • Type 2 diabetes requires ongoing management to achieve glycemic control, often necessitating treatment intensification.
  • Therapeutic inertia, a barrier to optimal diabetes care, can be addressed through clinical decision support tools.
  • Electronic health records (EHRs) offer a platform for integrating tools to aid in diabetes management and treatment intensification.

Purpose of the Study:

  • To evaluate the effectiveness of an EHR-based diabetes intensification tool in improving A1C goal attainment for patients with type 2 diabetes.
  • To assess the impact of the tool on treatment intensification rates and time to intensification.
  • To identify factors influencing the adoption and utilization of the EHR tool in a clinical setting.

Main Methods:

  • A stepped-wedge design was employed for the sequential implementation of an EHR-based diabetes intensification tool across a health system.
  • Implementation (IMP) and non-implementation (non-IMP) sites were retrospectively compared using overlap propensity score weighting.
  • A1C outcomes, tool usage rates, and treatment intensification metrics were analyzed at 6 and 12 months post-implementation.

Main Results:

  • Overall utilization of the EHR tool was low (9.7% of patient encounters).
  • No significant improvement in A1C goal attainment (<8%) was observed at 6 or 12 months between IMP and non-IMP sites.
  • In phase 3, A1C goal attainment at 12 months was lower in IMP sites compared to non-IMP sites (46.7% vs. 52.3%, P=0.02).
  • Mean A1C changes and times to treatment intensification did not differ significantly between IMP and non-IMP sites.

Conclusions:

  • Low utilization of the EHR-based diabetes intensification tool did not improve A1C goal attainment or expedite treatment intensification.
  • The limited adoption of the tool underscores the challenge of therapeutic inertia in routine clinical practice.
  • Further research is needed to develop strategies that enhance the integration, acceptance, and proficiency of EHR-based clinical decision support tools.