Electronic health records (EHRs) prove to be effective for creating registries that refer patients with prediabetes to prevention programs, according to recently published findings from a Medicare demonstration project and highlighted by the American Medical Association (AMA).
A team of AMA researchers field-tested the effectiveness of EHR patient registries as part of a pilot study to evaluate routine screening, testing and referral of patients to a YMCA diabetes prevention program (DPP).
Primary care practices and health systems were provided with an AMA-developed “retrospective prediabetes identification and intervention algorithm,” which entailed querying an EHR to identify patients with prediabetes, according to the medical association’s officials. Use of an EHR-based registry is among the methods covered in the AMA’s Diabetes Prevention Guide, which supports physicians and healthcare organizations in defining and implementing evidence-based diabetes prevention strategies.
“This approach ensured that as many Medicare-eligible patients with prediabetes were identified, an opportunity that is often missed during an acute or routine visit when competing priorities exist,” stated Christopher S. Holliday, Ph.D., the AMA’s director of population health and clinical-community linkages.
Of 5,640 patients referred to a DPP in the study, 4,601 patients at 12 clinical care settings were referred through a registry system, one of two approaches tested. The AMA partnered with the YMCA of the USA in the demonstration project, and patients were referred to DPPs at local YMCAs. In the study, clinical practice or health system staff used the registries to contact patients by telephone, email or letter regarding their prediabetes condition.
The demonstration study also compared the patient registry method with a point-of-care model. The point-of-care model was used by 10 practices and produced a substantially smaller number of referrals than EHR registries—437—but also had a markedly higher percentage of enrollments—56 percent versus 11 percent for the registry method. Four practices combined a registry with a point-of -care model, resulting in 602 referrals, with 51 percent of patient enrollments, the data revealed.
Medical records were then flagged so physicians could discuss participation in a DPP at the next patient encounter. For patients who chose not to participate in the DPP, the system made physicians aware that a discussion about diabetes prevention though lifestyle changes was warranted, and encouraged physicians to promote patient enrollment in a DPP.
“Most electronic health records systems are already configured to create a patient registry,” Holliday said. Once established, registries are “relatively easy to maintain”—a smaller practice without a registry-enabled EHR could even use a standard spreadsheet—and are a “very effective clinical principle and practice to help physicians and care teams” identify and reach out to patients requiring referrals.
The study also helped lead to Medicare coverage of Centers for Disease Control and Prevention-recognized lifestyle-change programs. Starting in April 2018, Centers for Medicare & Medicaid Services-approved organizations started billing the Medicare Diabetes Prevention Program (MDPP) expanded model.
Holliday is a community psychologist and the principal investigator for “Clinical Identification and Referral of Adults with Prediabetes to a Diabetes Prevention Program,” which appeared in Preventing Chronic Disease, published online by the CDC. The study was co-written by AMA colleagues Janet Williams and Vanessa Salcedo, as well as Namratha R. Kandula, M.D., of the Northwestern University Feinberg School of Medicine.
