Effects of an Electronic Health Record Choice Architecture Intervention on Inpatient Hemoglobin A1c Testing Rates and...

Area of Science:

• Healthcare quality improvement
• Clinical informatics
• Diabetes management

Background:

• Current guidelines recommend Hemoglobin A1c (HbA1c) testing for inpatients with diabetes or hyperglycemia if no recent result is available.
• Adherence to these guidelines for inpatient HbA1c testing is often suboptimal.
• Electronic health record (EHR) systems offer potential for interventions to improve guideline adherence.

Purpose of the Study:

• To evaluate the effectiveness of a simple EHR intervention in improving inpatient HbA1c testing rates.
• To assess the impact of improved HbA1c testing on patient outcomes, specifically 30-day readmission rates.

Main Methods:

• A retrospective cohort study design was employed.
• The intervention involved changing the default status of the HbA1c order from unselected to preselected within the subcutaneous insulin order set in the EHR.
• Adult inpatients with diabetes were compared between pre-intervention and post-intervention periods.

Main Results:

• HbA1c testing rates significantly increased from 64.7% to 78.8% post-intervention (p<0.001).
• This improvement was observed across various admitting specialties, including Internal Medicine, Surgery, Intensive Care, and Psychiatry.
• The intervention was associated with a significant decrease in 30-day readmission rates (OR 0.88, 95%CI 0.78-0.998; p = 0.046).

Conclusions:

• A straightforward, scalable EHR intervention effectively increased inpatient HbA1c testing rates.
• The intervention demonstrated a significant association with reduced 30-day readmissions.
• Further research is warranted to validate these findings and explore broader implications.