Comparative Effectiveness of Team-Based Care With and Without a Clinical Decision Support System for Diabetes Management

医学 糖尿病 比较有效性研究 决策支持系统 2型糖尿病 糖尿病管理 临床决策支持系统 重症监护医学 家庭医学 替代医学 内分泌学 计算机科学 病理 人工智能
作者
Xiulin Shi,Jiang He,Mingzhu Lin,Changqin Liu,Bing Yan,Haiqu Song,Caihong Wang,Fangsen Xiao,Peiying Huang,Liying Wang,Zhibin Li,Yinxiang Huang,Mulin Zhang,Chung-Shiuan Chen,Katherine Obst,Lizheng Shi,Weihua Li,Shuyu Yang,Guanhua Yao,Xuejun Li
出处
期刊:Annals of Internal Medicine [American College of Physicians]
卷期号:176 (1): 49-58 被引量:13
标识
DOI:10.7326/m22-1950
摘要

Uncontrolled hyperglycemia, hypercholesterolemia, and hypertension are common in persons with diabetes.To compare the effectiveness of team-based care with and without a clinical decision support system (CDSS) in controlling glycemia, lipids, and blood pressure (BP) among patients with type 2 diabetes.Cluster randomized trial. (ClinicalTrials.gov: NCT02835287).38 community health centers in Xiamen, China.11 132 persons aged 50 years or older with uncontrolled diabetes and comorbid conditions, 5475 receiving team-based care with a CDSS and 5657 receiving team-based care alone.Team-based care was delivered by primary care physicians, health coaches, and diabetes specialists in all centers. In addition, a computerized CDSS, which generated individualized treatment recommendations based on clinical guidelines, was implemented in 19 centers delivering team-based care with a CDSS.Coprimary outcomes were mean reductions in hemoglobin A1c (HbA1c) level, low-density lipoprotein cholesterol (LDL-C) level, and systolic BP over 18 months and the proportion of participants with all 3 risk factors controlled at 18 months.During the 18-month intervention, HbA1c levels, LDL-C levels, and systolic BP significantly decreased by -0.9 percentage point (95% CI, -0.9 to -0.8 percentage point), -0.49 mmol/L (CI, -0.53 to -0.45 mmol/L) (-19.0 mg/dL [CI, -20.4 to -17.5 mg/dL]), and -9.1 mm Hg (CI, -9.9 to -8.3 mm Hg), respectively, in team-based care with a CDSS and by -0.6 percentage point (CI, -0.7 to -0.5 percentage point), -0.32 mmol/L (CI, -0.35 to -0.29 mmol/L) (-12.5 mg/dL [CI, -13.6 to -11.3 mg/dL]), and -7.5 mm Hg (CI, -8.4 to -6.6 mm Hg), respectively, in team-based care alone. Net differences were -0.2 percentage point (CI, -0.3 to -0.1 percentage point) for HbA1c level, -0.17 mmol/L (CI, -0.21 to -0.12 mmol/L) (-6.5 mg/dL [CI, -8.3 to -4.6 mg/dL]) for LDL-C level, and -1.5 mm Hg (CI, -2.8 to -0.3 mm Hg) for systolic BP. The proportion of patients with controlled HbA1c, LDL-C, and systolic BP was 16.9% (CI, 15.7% to 18.2%) in team-based care with a CDSS and 13.0% (CI, 11.7% to 14.3%) in team-based care alone.There was no usual care control, and clinical outcome assessors were unblinded; the analysis did not account for multiple comparisons.Compared with team-based care alone, team-based care with a CDSS significantly reduced cardiovascular risk factors in patients with diabetes, but the effect was modest.Xiamen Municipal Health Commission.
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