Increasing Diabetes Self-Management Education and Support Referrals with an Electronic Best Practice Advisory

Diabetes self-management education and support (DSMES) services are often underutilized, partly due to low referral rates by clinicians. This examines if using a Best Practice Advisory (BPA) integrated into the electronic health record (EHR) during clinic visits increases DSMES referral rates.

We developed a BPA within the Epic EHR for patients with type 2 diabetes (T2D) eligible for DSMES services. This BPA was implemented in four primary care practices within a university-based health system, while two additional practices served as controls. We analyzed data using multilevel logistic regression with patient data nested within clinicians. We employed binary logit functions and maximum likelihood estimation to assess the odds of DSMES referrals postvisit. Both unadjusted and adjusted models were tested, accounting for clinic and patient variables.

From April 1, 2023, to March 31, 2024, 2,526 BPAs were deployed in intervention clinics, resulting in a 12.9% DSMES referral rate. In contrast, control clinics had 1,444 eligible patient visits with a 1.2% referral rate (p<0.001).

Integrating BPA prompts into the EHR significantly enhances DSMES referral rates. This approach effectively identifies eligible patients and simplifies the referral process, addressing some barriers to DSMES utilization.