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

Laura A Young; Jacqueline R Halladay; Ping Chen; Kathleen Mottus; Karen Goeke-Austin; Jennifer Rees; Maihan B Vu; Erica L Richman; Jordan Sharpe; Aaron Thomas; Katrina E Donahue

doi:10.3122/jabfm.2025.250280R1

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Figure 1. CONSORT Flow Diagram for Study Enrollment.

Tables

Figures

View popup

Table 1. Baseline Characteristics of Patients Eligible for Diabetes Self-Management Education Support (DSMES) Services, N = 3,970.

	Control Practices (N=2)	Intervention Practices (N=4)	Total (N=6)	P-Value
Total Patients	1,444 (36.4%)	2,526 (63.6%)	3,970 (100%)	---
Age (SD)	65.7 (15.9)	64.4 (15.0)	64.9 (15.3)	0.010
Sex				0.053
Male	598 (41.4%)	1,126 (44.6%)	1,724 (43.4%)
Female	846 (58.6%)	1,400 (55.4%)	2,246 (56.6%)
Race				0.112
White	960 (66.5%)	1,583 (62.7%)	2,543 (64.1%)
Black	409 (28.3%)	802 (31.7%)	1,211 (30.5%)
Asian	30 (2.1%)	53 (2.1%)	83 (2.1%)
Other	45 (3.1%)	88 (3.5%)	133 (3.4%)
Ethnicity				0.346
Non-Hispanic	1,397 (96.7%)	2,457 (97.3%)	3,854 (97.1%)
Hispanic	47 (3.3%)	69 (2.7%)	116 (2.9%)
Marital Status				0.048
Married	818 (56.6%)	1,349 (53.4%)	2,167 (54.6%)
Other Statuses	626 (43.4%)	1,177 (46.6%)	1,803 (45.4%)
Rurality				0.035
Urban	1,372 (95.0%)	2,435 (96.4%)	3,807 (95.9%)
Rural	72 (5.0%)	91 (3.6%)	163 (4.1%)
Insurance				0.000
Commercial	402 (27.8%)	926 (36.7%)	1,328 (33.5%)
Medicaid	85 (5.9%)	139 (5.5%)	224 (5.6%)
Medicare	939 (65.0%)	1,423 (56.3%)	2,362 (59.5%)
Self-Pay	18 (1.2%)	38 (1.5%)	56 (1.4%)
Comorbidity Count (SD)	1.6 (1.3)	1.6 (1.2)	1.6 (1.3)	0.124
Number of primary care appointments in past year (SD)	4.4 (3.1)	4.2 (2.9)	4.3 (3.0)	0.150
DSMES Eligibility Criteria*
A1C>8.5	324 (22.4%)	573 (27.7%)	897 (22.6%)	0.858
New diabetes diagnosis	296 (20.5%)	720 (28.5%)	1,016 (25.6%)	<0.001
Hospitalization	507 (35.1%)	933 (36.9%)	1,440 (36.3%)	0.250
New diabetes related comorbidities	637 (44.1%)	952 (37.7%)	1,589 (40.0%)	<0.001
Number of Eligibility Criteria (SD)	1.2 (0.5)	1.3 (0.5)	1.2 (0.5)	0.030
DSMES order placed	18 (1.2%)	325 (12.9%)	343 (8.6%)	<0.001

*Each criterion is coded as a binary variable, and the table shows only the percentage of patients who meet each criterion. Patients may be eligible for more than one criterion.

View popup

Table 2. Multilevel Mixed Logit Models Estimating Odds Ratios of Referral for Diabetes Self-Management Education Support (DSMES) Services During Clinic Visits

	Model 1 (Unadjusted)		Model 2 (Adjusted)
	OR	95% CI	OR	95% CI
Intervention clinic	10.64^***	[4.96, 22.9]	10.55***	[4.65, 23.94]
Age			0.99	[0.98, 1.01]
Female			0.93	[0.73, 1.19]
Race (ref: White)
Black			1.55^**	[1.19, 2.02]
Asian American			1.31	[0.64, 2.68]
Other			0.68	[0.32, 1.46]
Hispanic			2.16^*	[1.05, 4.43]
Married			0.97	[0.75, 1.25]
Rural			1.00	[0.53, 1.87]
Insurance (ref: Commercial)
Medicaid			1.01	[0.57, 1.78]
Medicare			0.87	[0.61, 1.25]
Self-Pay			0.73	[0.24, 2.21]
Comorbidity Count			1.26^***	[1.13, 1.40]
Number of primary care appointments in past year			0.96	[0.92, 1.00]
Reason for referral (ref: Hospitalization)^a
A1C>8.5			3.78^***	[2.52, 5.68]
New diabetes diagnosis			5.72^***	[3.90, 8.41]
New diabetes-related comorbidities			1.39	[0.93, 2.06]
Intercept	0.01^***	[0.01, 0.02]	0.01^***	[0.00, 0.02]