Using information technology to tailor diabetes care
A tracking system can tailor care and boost self-management in patients with diabetes.
The effectiveness of this ongoing tracking system for patients with diabetes was evaluated during a 1-year period. Selected outcomes for diabetes in a rural nurse practitioner (NP)—managed clinic were compared with data from statewide clinics for the same outcomes. The purpose of comparing NP data with statewide data was to examine the overall effectiveness and consistency of diabetic care provided by the NP clinic while using the CDEMS.
Demographic and clinical data
It is estimated that there are 272,309 people with diabetes in the state of Kansas, including 69,000 persons with undiagnosed diabetes.8 Demographic data were collected from 56 patients seen in the NP clinic and compared with demographic data from 6949 patients with diabetes tracked throughout the state. The results of the comparison are presented in Table 1. Most of the patients seen in both the NP clinic and the statewide clinics were female, white, and aged older than 65 years. In addition, clinical data were gathered for each diabetes-related appointment at the NP clinic and entered into the CDEMS database. A comparison of the clinical data from the NP clinic with the clinical data from the statewide clinics data is presented in Table 2.
Analysis of clinical data
About 80 clinics reported data across the state. The data for HbA1C levels, lipid profiles, blood pressure, body mass index, and demographic characteristics were accurately recorded in all the clinics. The statewide data for tobacco use and associated health conditions appeared to be inconsistently recorded. This variability between the data for the NP clinic and the data for the statewide clinics is thought to be the result of inconsistencies in recording the data. Therefore, the analysis of the data focuses primarily on the accurately recorded parameters.
The average HbA1C value from the NP clinic (7.1) is lower than the average statewide value (7.4). This difference may reflect the consistent management of a smaller group of patients with diabetes and care provided by one provider in a personalized setting within a small rural community. Patients were well-known to the NP, and frequent follow-up led to better compliance. The statewide data reflect a broader, more heterogeneous population with diverse ethnic backgrounds and greater variance in other risk factors.
The average lipid profile values were similar for the NP clinic and the statewide clinics, except for the triglyceride value. The average triglyceride value of the patients in the NP clinic was markedly elevated at 423.4 mg/dL, whereas the average value for the patients in the statewide clinics was 186 mg/dL. This is believed to reflect the high percentage of patients in the NP clinic with a BMI of 40 or higher. The exact cause of the elevated BMI and triglyceride values is unknown but is believed to be related to the dietary intake and other lifestyle patterns of a rural, low-income population. There is a correlation between a high BMI and a high plasma triglyceride level.9
A comparison of blood pressure values between the NP clinic and the statewide clinics showed a higher percentage of patients with elevated blood pressure in the NP clinic. Data are missing for a large number of patients in the statewide clinics and therefore, a comparison cannot be made.