Diabetes Decision Support: Initial Experience With the Vermont Diabetes Information System.

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Author: MacLean, Charles D.1 charles.maclean@vtmednet.orgLittenberg, Benjamin1Gagnon, Michael1,2

Interventions that have proven effective in the management of chronic illness have often been difficult to establish in widespread practice. The Chronic Care Model provides a framework for implementing interventions, but it is expensive and difficult to implement.

We developed a decision support system based on this model to improve the care of adults who have diabetes and receive primary care in Vermont or adjacent New York. The Vermont Diabetes Information System uses a network of community laboratories for providing data to produce flowsheets, reminders, action alerts, and population reports that are sent to primary care providers by fax and to patients by mail. Currently, 7295 patients are cared for by 124 primary care providers in 62 practices and are enrolled in a randomized controlled trial to study its effects.

Despite evidence that optimal diabetes care can result in reduced complications and improved economic outcomes, such care is often not achieved. A recent study of outcomes among diabetic patients by the National Health and Nutrition Examination Survey found that 37% had poor glycemic control (hemoglobin A1C>8%), 40% had blood pressure values greater than 140/90 mm Hg, and more than 50% had cholesterol levels greater than 200 mg/dL.((n5.) MacLean CD, Littenberg B, Gagnon MS, Reardon M, Turner PD, Jordan C. The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a duster randomized trial of a decision support system in a regional sample of primary care practices. Clin Trials. 2004;1:532-544.