Evaluating Diabetes Outcomes and Costs Within an Ambulatory Setting: A Strategic Approach Utilizing a Clinical Decision Support System

Diabetes affects 22.3 million people in the United States.1 It is a major cause of heart disease and stroke and is the seventh leading cause of death.2 Patients with diabetes are at two to four times greater risk of myocardial infarction (MI) than those without diabetes, and diabetes is the primary reason for renal failure, blindness, and nontraumatic limb amputations.3 Preventive care practices can reduce the development of severe vision loss by 50–60%, reduce foot amputations by 45–85%, and lower blood pressure to reduce proteinuria, a risk factor for developing kidney disease, by ~ 35%.2 Despite evidence that complications related to diabetes are preventable,4,5 only 52% of individuals with diabetes meet guidelines targeting an A1C of < 7.0%, and only 18% meet combined glycemic, lipid, and blood pressure goals.6 In addition to significant morbidity, diabetes has a substantial financial impact. Medical expenses for people with diabetes are more than two times higher than for those without diabetes.2 Total national health care and related costs for the treatment of all people with diabetes total ~ $245 billion.1 Complications from diabetes, such as chronic kidney disease, can cost health care organizations $33 billion per year.2 Most diabetes care is provided in the community in the primary care setting,3 and diabetes is the fourth most frequent reason for ambulatory physician visits.7 A gap exists between optimal and actual care, constituting a wide “quality chasm,”8 which underscores the need for innovative approaches to change the current practice of diabetes care. Clinical decision support systems (CDSSs) have been suggested as a viable solution to these pressing issues.9 CDSSs have been defined as systems providing an automated process for comparing patient-specific characteristics against a computerized knowledge base, with resulting recommendations or …