From design to implementation - The Joint Asia Diabetes Evaluation (JADE) program: A descriptive report of an electronic web-based diabetes management program

BackgroundThe Joint Asia Diabetes Evaluation (JADE) Program is a web-based program incorporating a comprehensive risk engine, care protocols, and clinical decision support to improve ambulatory diabetes care.MethodsThe JADE Program uses information technology to facilitate healthcare professionals to create a diabetes registry and to deliver an evidence-based care and education protocol tailored to patients' risk profiles. With written informed consent from participating patients and care providers, all data are anonymized and stored in a databank to establish an Asian Diabetes Database for research and publication purpose.ResultsThe JADE electronic portal (e-portal: http://www.jade-adf.org) is implemented as a Java application using the Apache web server, the mySQL database and the Cocoon framework. The JADE e-portal comprises a risk engine which predicts 5-year probability of major clinical events based on parameters collected during an annual comprehensive assessment. Based on this risk stratification, the JADE e-portal recommends a care protocol tailored to these risk levels with decision support triggered by various risk factors. Apart from establishing a registry for quality assurance and data tracking, the JADE e-portal also displays trends of risk factor control at each visit to promote doctor-patient dialogues and to empower both parties to make informed decisions.ConclusionsThe JADE Program is a prototype using information technology to facilitate implementation of a comprehensive care model, as recommended by the International Diabetes Federation. It also enables health care teams to record, manage, track and analyze the clinical course and outcomes of people with diabetes.

[1]  R. Ozaki,et al.  Association of statin use and development of renal dysfunction in type 2 diabetes--the Hong Kong Diabetes Registry. , 2010, Diabetes research and clinical practice.

[2]  A. Kong,et al.  End-stage renal disease risk equations for Hong Kong Chinese patients with type 2 diabetes: Hong Kong Diabetes Registry , 2006, Diabetologia.

[3]  A. Karter,et al.  Developing a prediction rule from automated clinical databases to identify high-risk patients in a large population with diabetes. , 2001, Diabetes care.

[4]  R. Ozaki,et al.  Effect of interactions between C peptide levels and insulin treatment on clinical outcomes among patients with type 2 diabetes mellitus , 2009, Canadian Medical Association Journal.

[5]  Xilin Yang,et al.  Development and validation of a total coronary heart disease risk score in type 2 diabetes mellitus. , 2008, The American journal of cardiology.

[6]  Philip D. Harvey,et al.  Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39 , 1998, BMJ.

[7]  M. Courtney,et al.  Self-efficacy, outcome expectations and self-care behaviour in people with type 2 diabetes in Taiwan. , 2007, Journal of clinical nursing.

[8]  A. Kong,et al.  Low LDL Cholesterol, Albuminuria, and Statins for the Risk of Cancer in Type 2 Diabetes , 2009, Diabetes Care.

[9]  Rod Jackson,et al.  Integrated electronic decision support increases cardiovascular disease risk assessment four fold in routine primary care practice , 2008, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[10]  Malcolm Maclure,et al.  Information system support as a critical success factor for chronic disease management: Necessary but not sufficient , 2006, Int. J. Medical Informatics.

[11]  Ho-Young Son,et al.  Epidemic obesity and type 2 diabetes in Asia , 2006, The Lancet.

[12]  S. Feasson,et al.  MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20536 high-risk individuals : a randomised placebo-controlled trial. , 2008 .

[13]  Song-min Huang,et al.  Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. , 2006, Journal of the American Society of Nephrology : JASN.

[14]  G. Divine,et al.  A Web-based diabetes care management support system. , 2001, The Joint Commission journal on quality improvement.

[15]  J. Chan,et al.  Effects of structured care by a pharmacist-diabetes specialist team in patients with type 2 diabetic nephropathy. , 2005, The American journal of medicine.

[16]  A. Kong,et al.  The Joint Asia Diabetes Evaluation (JADE) Program: a web‐based program to translate evidence to clinical practice in Type 2 diabetes , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[17]  Xilin Yang,et al.  Development and validation of an all-cause mortality risk score in type 2 diabetes. , 2008, Archives of internal medicine.

[18]  O. Pedersen,et al.  Effect of a multifactorial intervention on mortality in type 2 diabetes. , 2008, The New England journal of medicine.

[19]  B. Brenner,et al.  Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. , 2001, The New England journal of medicine.

[20]  Clinical Practice Recommendations 2005. , 2005, Diabetes care.

[21]  M. Engelgau,et al.  A Diabetes Report Card for the United States: Quality of Care in the 1990s , 2002, Annals of Internal Medicine.

[22]  J. Chan,et al.  Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial , 2006, BMJ : British Medical Journal.

[23]  M. Fowler Clinical Practice Recommendations , 2009, Clinical Diabetes.

[24]  J. Chan,et al.  Effects of Structured Versus Usual Care on Renal Endpoint in Type 2 Diabetes: The SURE Study , 2009, Diabetes Care.

[25]  Gretchen A. Piatt,et al.  Translating the Chronic Care Model Into the Community: Results From a Randomized Controlled Trial of a Multifaceted Diabetes Care Intervention , 2006, Diabetes Care.

[26]  Idf Clinical Guidelines Task Force Global Guideline for Type 2 Diabetes: recommendations for standard, comprehensive, and minimal care , 2006, Diabetic medicine : a journal of the British Diabetic Association.

[27]  S. Yusuf MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Commentary , 2002 .

[28]  M. Engelgau,et al.  Improvements in Diabetes Processes of Care and Intermediate Outcomes: United States, 19882002 , 2006, Annals of Internal Medicine.

[29]  S. Pang,et al.  Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus. , 2008, Journal of advanced nursing.

[30]  R. Ozaki,et al.  Use of anti-diabetic drugs and glycaemic control in type 2 diabetes-tThe Hong Kong Diabetes Registry. , 2008, Diabetes research and clinical practice.

[31]  M. Engelgau,et al.  Translation research for chronic disease: the case of diabetes. , 2000, Diabetes care.

[32]  Weiping Jia,et al.  Diabetes in Asia: epidemiology, risk factors, and pathophysiology. , 2009, JAMA.

[33]  Vivian Wong,et al.  Development and Validation of Stroke Risk Equation for Hong Kong Chinese Patients With Type 2 Diabetes , 2007, Diabetes Care.

[34]  Colin Mathers,et al.  The burden of mortality attributable to diabetes: realistic estimates for the year 2000. , 2005, Diabetes care.

[35]  J. Pickup,et al.  Textbook of Diabetes , 1991 .

[36]  M. Fowler,et al.  Clinical Practice Recommendations , 2009, Clinical Diabetes.

[37]  J. Chan,et al.  Modified end-stage renal disease risk score for Chinese type 2 diabetic patients—the Hong Kong Diabetes Registry , 2007, Diabetologia.

[38]  Rury R Holman,et al.  Long-term follow-up after tight control of blood pressure in type 2 diabetes. , 2008, The New England journal of medicine.

[39]  Uk-Prospective-Diabetes-Study-Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[40]  Frederick Bloom,et al.  Employing the Electronic Health Record to Improve Diabetes Care: A Multifaceted Intervention in an Integrated Delivery System , 2008, Journal of General Internal Medicine.

[41]  Xilin Yang,et al.  Impacts of chronic kidney disease and albuminuria on associations between coronary heart disease and its traditional risk factors in type 2 diabetic patients – the Hong Kong diabetes registry , 2007, Cardiovascular Diabetology.

[42]  B. Brenner,et al.  The renoprotective effects of structured care in a clinical trial setting in type 2 diabetic patients with nephropathy. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[43]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[44]  S. Yusuf,et al.  Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. , 2000 .

[45]  Xilin Yang,et al.  Associations of Hyperglycemia and Insulin Usage With the Risk of Cancer in Type 2 Diabetes: The Hong Kong Diabetes Registry , 2010, Diabetes.

[46]  A. Kong,et al.  Risk factors in V‐shaped risk associations with all‐cause mortality in type 2 diabetes—The Hong Kong Diabetes Registry , 2008, Diabetes/metabolism research and reviews.

[47]  D. Boyle,et al.  The diabetes audit and research in Tayside Scotland (darts) study: electronic record linkage to create a diabetes register , 1997, BMJ.

[48]  P Sönksen,et al.  Information technology in diabetes care 'Diabeta': 23 years of development and use of a computer-based record for diabetes care. , 1996, International journal of bio-medical computing.

[49]  H. Parving,et al.  The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. , 2001, The New England journal of medicine.

[50]  J. Grimshaw,et al.  From best evidence to best practice: effective implementation of change in patients' care , 2003, The Lancet.

[51]  R. Holman,et al.  10-year follow-up of intensive glucose control in type 2 diabetes. , 2008, The New England journal of medicine.

[52]  J. Chan,et al.  Effects of protocol-driven care versus usual outpatient clinic care on survival rates in patients with type 2 diabetes. , 2003, The American journal of managed care.