Use of an Electronic Health Record Order to Directly Refer Patients With Prediabetes to Community-Based Diabetes...

Rates of participation in community-based diabetes prevention programs (DPPs) are low among patients with prediabetes. This may be due, in part, to low rates of referrals to these programs from health systems. One key opportunity to augment clinicians' referrals to and patients' participation in DPPs may be through electronic health record referrals (eReferrals).

We undertook a quality improvement initiative in a large, academic health system. Using the EpicCare Link feature of Epic (Epic Systems Corporation), we created an eReferral to local community-based DPPs. Eligibility criteria required that patients have an age of at least 18 years, a body mass index of at least 25 kg/m², and prediabetes or a history of gestational diabetes. We conducted a retrospective evaluation of implementation outcomes from June 1, 2021 to June 30, 2022 using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) evaluation framework.

During the evaluation period, 577 patients were referred to DPPs and 21% enrolled, defined as attending an information session and registering for a program. Thirty percent of 350 targeted primary care clinicians used the eReferral across 14 primary care clinics. Among all 124 referring clinicians, referral rates varied widely with a range of 1 to 46 referrals per clinician; 11% of referring clinicians contributed more than 50% of all referral orders. The large majority of referred patients (73% to 81%) met DPP eReferral eligibility criteria.

An eReferral is a promising, scalable strategy to connect patients with prediabetes to community DPPs. Additional strategies are needed to enhance clinicians' use of the eReferral and patients' subsequent program engagement to fully optimize the reach and effectiveness of DPPs.