Use of Technology to Track Program Outcomes in a Diabetes Self-Management Program

doi:10.1016/j.jada.2005.07.013

Journal of the American Dietetic Association

Volume 105, Issue 12, December 2005, Pages 1933-1938

https://doi.org/10.1016/j.jada.2005.07.013 Get rights and content

Abstract

The Diabetes Self-Management Education Program at MetroHealth Medical Center in Cleveland, OH, uses widely available technology to facilitate outcomes tracking and market the diabetes program. Baseline assessment data are entered directly into an Access database form (Microsoft, Inc, Seattle, WA). Quarterly, updated weight and lab data are downloaded into the database from the Epicare electronic medical record (Epic Systems Corp, Madison, WI). This system has enabled staff to track outcomes of program participants on an ongoing basis. To date, 438 patients have been entered into the program database, though complete clinical data are not available for all patients. Mean (±standard deviation) baseline body mass index of program participants was 35.8±9.1 (range 18.0 to 70.0, n=261). Mean (±standard deviation) baseline hemoglobin A1c (HbA1c) for all patients was 9.5%±2.5%, range 4.5% to 18.3% (n=332). Median baseline HbA1c was 9.1%, and the median last available postprogram HbA1c was 7.5% (P<.001, n=216; patients ranged from 90 days to more than 3 years postprogram entry). Weight change was not significant. In patients 1-year postprogram (n=72), mean baseline HbA1c was 9.9%±2.9% and the mean 1-year HbA1c value was 7.4%±1.7%, P<.001. At 1 year, 75% of patients had HbA1c ≤8%. In response to these outcomes, an alert was implemented in the outpatient charting system triggered by an HbA1c >8.5% and recommending referral to the Diabetes Self-Management Education Program. Since implementation of the prompt, referrals to the program have increased 40%.

Section snippets

Methods

An electronic order set for the Diabetes Self-Management Education Program was created in the Epic online order system (Figure 1). The order set was designed to meet regulatory requirements for patient referral and diagnosis. It includes explicit diagnostic criteria for diabetes, appropriate lab orders, and referrals for Medical Nutrition Therapy and Diabetes Self Management Training, the two components of the Diabetes Management Program. Referrals are transmitted electronically to the clinical

Results and Discussion

To date, 438 patients have been entered onto the program roster, meaning they participated in at least one class session. Mean age (±standard deviation) at referral was 53±12.6 years (range 20 to 85 years, n=438). Demographically, patients in the program mirror MetroHealth’s diverse diabetic population, being 45% white, 43% African American, 9% Hispanic, and 3% other (n=435). Sixty-two percent are women, 38% men; 32% are married, while 68% are single, separated, widowed, or divorced. Mean

Conclusions

Providers of medical nutrition therapy and diabetes self-management training share the challenge of devising effective outcomes management systems that can be used in live clinical settings. Ideally, computerized systems should communicate with electronic medical records already present in the health care environment to minimize the manual work required to transfer data from one system to another. Because this system utilizes standard database and spreadsheet technology, user support is

C. S. Chima is an assistant professor, Department of Family and Consumer Sciences, University of Akron, Akron, OH.

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C. S. Chima is an assistant professor, Department of Family and Consumer Sciences, University of Akron, Akron, OH.

N. Farmer-Dziak is director of Clinical Nutrition, MetroHealth System, Cleveland, OH.

P. Cardwell is a clinical dietitian

S. Snow is a coordinator/dietitian in the Department of Pediatrics, both at MetroHealth Medical Center, Cleveland, OH.

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ResearchPerspectives in PracticeUse of Technology to Track Program Outcomes in a Diabetes Self-Management Program

Abstract

Section snippets

Methods

Results and Discussion

Conclusions

J Am Diet Assoc.

J Am Diet Assoc.

National Standards for Diabetes Self Management Education

Diabetes Care.

Position of the American Dietetic AssociationNutrition services in managed care

J Am Diet Assoc.

Standards for outcomes measurement of diabetes self-management education

Diabetes Educ.

Research
Perspectives in Practice
Use of Technology to Track Program Outcomes in a Diabetes Self-Management Program