medwireNews: A health informatics system based on routine clinical data helps physicians to prioritize high-risk people with diabetes, deliver more equitable care, and manage healthcare capacity, report researchers.
Janaka Karalliedde of Guy’s and St Thomas’ NHS Foundation Trust in London, UK, revealed the findings at the 16th ATTD conference in Berlin, Germany.
He described the system as “an opportunity for us to change the way we deliver care – looking at prioritization in a more sophisticated, data-driven way, where people who are at lower risk may be given opportunities for [patient-initiated] follow-up, remote monitoring, to enable capacity to see those at higher risk more promptly.”
The system categorized people according to the recent occurrence of six high-risk events: receipt of diabetes-related emergency healthcare; a glycated hemoglobin measurement that was greater than 86 mmol/mol (>10%), less than 48 mmol/mol (<6.5%), or had changed by more than 20 mmol/mol (>4%) in either direction; a fall in estimated glomerular filtration rate greater than 15 mL/min per 1.73 m2; or receipt of treatment for advanced diabetic eye disease.
One or more of these events had occurred in 16.3% of 4013 adults with diabetes (48% women, 20% with type 1 diabetes) since their most recent clinic visit at a large London hospital. These 656 people were more frequently non-Caucasian and from a more deprived socioeconomic background than those without recent high-risk events, and about 7% were not due to be seen for at least 3 months or had no booked appointment.
Conversely, 174 people with “encouraging” glycemic and renal data were given a green flag, allowing physicians to reschedule forthcoming clinic visits by moving these people to later dates, ensuring that red-flagged people were offered an appointment date within the next 3 months.
For testing purposes, nine clinicians studied the data of 450 study participants and red-flagged those with concerning health indicators; the automatic system identified 83% of these people, as well as 81% of those green-flagged by the clinicians.
Karalliedde described this as “relatively good,” taking into account that clinicians “have varied degrees of risk awareness and risk threshold.”
The investigators then set up a high-risk clinic, in which they have so far seen nearly 100 people with diabetes. They believe that they have prevented harm – “predominantly hypoglycemia emergencies” – in about 40% of these people by bringing forward their clinic visits.
Moreover, the system may help to prevent health inequality, said Karalliedde, noting that 45% of the high-risk group was from an ethnic minority, compared with 30% of the overall cohort.
“Tools such as ours, we feel, can identify new, emerging risk, but most importantly deliver equitable, fairer healthcare, improve healthcare efficiency, and reduce the burden of complications in people with diabetes,” concluded the presenter.
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