Clinical decision support systems with team-based care on type 2 diabetes improvement for Medicaid patients: A quality improvement project

Background: The prevalence of clinical inertia, the failure of appropriate treatment intensification in diabetes treatment, is a well-documented worldwide phenomenon. This project addresses the problem of clinical inertia through three interrelated activities, clinical decision support (CDSS), team-based care, and patient engagement in diabetes management. Objectives: The purpose of this research is to provide analysis under the State-University Partnership Learning Network regarding the impact of an electronic decision support tool combined with team-based care workflow on provider decision-making and patient outcomes for the treatment of poorly controlled diabetes mellitus (diabetes) among patients receiving Kentucky Medicaid. The objectives of this study are to 1) assess clinical outcomes of type 2 diabetes in the Medicaid population with team-based care using CDSS, 2) evaluate physicians' and pharmacists' experience on CDSS. Methods: This is a quality improvement project using a mixed-method - longitudinal and control group comparison of outcomes based upon clinical measures and online surveys of providers and pharmacists involved in this project. Results: Patients treated by providers who changed the treatment regimen to one that either fully or partially followed the recommendation of the CDSS tool had a statistically significant reduction in HbA1c with an average initial HbA1c of 10.1 and the final HbA1c of 8. The online survey of physicians shows that more than 80% of physicians agree the use of CDSS will support improved patient outcomes. The use of a team-based care approach that includes pharmacists in implementing treatment changes was broadly supported by both physicians and pharmacists. Conclusion: CDSS combined with team-based care can be effective in reducing HbA1c to targeted therapeutic levels. The use of CDSS provides a way to efficiently assess more than 160 potential frontline drugs and properly accelerate treatment. Consistent with the research literature, the inclusion of pharmacists can play a key role in team-based care to assess treatment alternatives and provide for improvement in outcomes and patient adherence for diabetes. The user surveys show both physicians and pharmacists have a positive attitude toward CDSS.