OBJECTIVE
To determine the impact of a health system–wide primary care diabetes management system, which included targeted guidelines for type 2 diabetes (T2DM) and
prediabetes (dysglycemia) screening, on detection of previously undiagnosed dysglycemia cases.
RESEARCH DESIGN AND METHODS
Intervention included electronic health record (EHR)–based decision support and
standardized providers and staff training for using the American Diabetes Association
guidelines for dysglycemia screening. Using EHR data, we identified 40,456 adults
without T2DM or recent screening with a face-to-face visit (March 2011–December
2013) in five urban clinics. Interrupted time series analyses examined the impact of
the intervention on trends in three outcomes: 1) monthly proportion of eligible
patients receiving dysglycemia testing, 2) two negative comparison conditions (dysglycemia testing among ineligible patients and cholesterol screening), and 3) yield of
undiagnosed dysglycemia among those tested.
RESULTS
Baseline monthly proportion of eligible patients receiving testing was 7.4–10.4%.
After the intervention, screening doubled (mean increase + 11.0% [95% CI 9.0, 13.0],
proportion range 18.6–25.3%). The proportion of ineligible patients tested also increased (+5.0% [95% CI 3.0, 8.0]) with no concurrent change in cholesterol testing
(+0% [95% CI 20.02, 0.05]). About 59% of test results in eligible patients showed
dysglycemia both before and after the intervention.
CONCLUSIONS
Implementation of a policy for systematic dysglycemia screening including formal
training and EHR templates in urban academic primary care clinics resulted in a
doubling of appropriate testing and the number of patients who could be targeted
for treatment to prevent or delay T2DM.