medwireNews: Use of a computer clinical decision support system increases targeted screening of pediatric patients at risk for type 2 diabetes and boosts their attendance at follow-up appointments, shows a randomized trial.
The researchers used the type 2 diabetes module of the CHICA system, which is linked to patients’ electronic medical records and collates data obtained from parents, clinic staff, and the physician to ascertain diabetes risk based on the American Diabetes Association guidelines. So if a patient has a body mass index at or above the 85th percentile and two or more risk factors, the system prompts the physician to test the patient’s fasting blood glucose and/or glycated hemoglobin.
“The CHICA system is unique because it permits us to insert guideline-based care into existing clinic practices in a format that integrates easily into routine pediatric care,” observe Tamara Hannon (Indiana University School of Medicine, Indianapolis, USA) and co-researchers.
The study involved 1369 patients, 41.3% of whom met the screening criteria. The proportion meeting these criteria did not differ between two primary care clinics randomly assigned to use the decision support and two control clinics, yet the corresponding proportions who underwent screening during the study period were 14.4% versus 4.8%.
This amounted to an adjusted 3.7-fold increased likelihood of being screened at a clinic using the CHICA system, rising to a 4.6-fold increase among children meeting the screening criteria, with 31.4% versus 9.2% being screened at intervention and control clinics, respectively.
When tests were ordered, the results were more likely to be documented in the intervention than control clinics. The decision support system generated reminder telephone calls to attend follow-up appointments for patients found to have prediabetes, resulting in an attendance rate of 29.4% compared with 18.9% in the control clinics.
“Use of a computerized clinical decision support system to automate the identification and screening for [type 2 diabetes] can help overcome barriers to the screening process,” write the researchers in JAMA Pediatrics.
But they add: “Whether the system can help improve health outcomes in youth diagnosed with prediabetes or [type 2 diabetes] remains to be determined.”
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