1. Comparative Effectiveness of Team-Based Care With and Without Clinical Decision Support System for Diabetes Management : A Cluster Randomized Trial.
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Shi, Xiulin, He, Jiang, Lin, Mingzhu, Liu, Changqin, Yan, Bing, Song, Haiqu, Wang, Caihong, Xiao, Fangsen, Huang, Peiying, Wang, Liying, Li, Zhibin, Huang, Yinxiang, Zhang, Mulin, Chen, Chung-Shiuan, Obst, Katherine, Shi, Lizheng, Li, Weihua, Yang, Shuyu, Yao, Guanhua, and Li, Xuejun
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CLINICAL decision support systems , *HYPERGLYCEMIA , *CLUSTER randomized controlled trials , *TYPE 2 diabetes , *LDL cholesterol , *CARDIOVASCULAR diseases risk factors - Abstract
Background: Uncontrolled hyperglycemia, hypercholesterolemia, and hypertension are common in persons with diabetes.Objective: 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.Design: Cluster randomized trial. (ClinicalTrials.gov: NCT02835287).Setting: 38 community health centers in Xiamen, China.Patients: 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.Intervention: 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.Measurements: 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.Results: 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.Limitation: There was no usual care control, and clinical outcome assessors were unblinded; the analysis did not account for multiple comparisons.Conclusion: 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.Primary Funding Source: Xiamen Municipal Health Commission. [ABSTRACT FROM AUTHOR]- Published
- 2023
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