Eighty six million U.S. adults have prediabetes, and up to 70% of them will eventually develop diabetes. Large comparative effectiveness trials have established that intensive lifestyle interventions (ILI) and metformin are safe and effective treatments to prevent or delay diabetes in adults with prediabetes and overweight/obesity. Despite being included in expert clinical guidelines, these treatments are rarely used and few studies have explored how to promote their uptake in practice. One possible approach for increasing adoption of ILI and metformin in primary care includes clinical decision support (CDS), which uses electronic systems to create tailored recommendations for evidence-based clinical care. While a large body of evidence demonstrates that CDS can improve the delivery of other recommended preventive services, this approach has not been definitively studied for ILI and metformin. We plan to address this critical knowledge gap by developing and evaluating the Prevent Diabetes Mellitus Clinical Decision Support (PreDM CDS) intervention for community health center patients with prediabetes and overweight/obesity. This novel CDS engages the primary care team to deliver the following intervention components: 1) a decision aid about diabetes prevention developed by our group; 2) an EHR referral to community-based ILI programs that meet USPSTF requirements and are located in patients’ zip code; and 3) a prompt for clinicians to consider prescribing metformin. Clinicians will receive monthly feedback about their use of the PreDM CDS through an existing dashboard. By accomplishing the following specific aims, this definitive R18 study will test the potential for CDS to promote diabetes prevention and weight loss efforts in primary care. In Aim 1, we will develop the proposed intervention by translating narrative guidelines about ILI and metformin into CDS, while incorporating extensive feedback from the primary care team. Aim 2 is a pragmatic cluster randomized trial including 6 large community health center sites, which will examine the effectiveness of the PreDM CDS at inducing weight loss and improving other cardiometabolic markers. Aim 3 is a mixed-methods evaluation of the PreDM CDS, exploring its reach, adoption, implementation, maintenance, and costs. We hypothesize that the proposed PreDM CDS will increase patient’s adoption of ILI and metformin, producing modest weight loss and improvements in other cardiometabolic markers. The resulting data, and an implementation toolkit created by the study team, will support the widespread dissemination of the PreDM CDS if found to be effective in the proposed study. Our proposal is responsive to PA-16-282 by: 1) developing new CDS that incorporates understudied clinical guidelines for diabetes prevention; 2) partnering with the AHRQ National Guideline Clearinghouse in the development and implementation of the PreDM CDS; 3) evaluating the impact of the PreDM CDS on clinical workflows, healthcare process measures, adherence to guidelines, patient outcomes, and costs; and 4) conducting this study in a Health Center-Controlled Network that serves several AHRQ priority populations, and can disseminate the PreDM CDS to its national network of over 200 clinic sites.
|Effective start/end date||9/1/18 → 6/30/21|
- Agency for Healthcare Research and Quality (5R18HS026172-03)