Development and Validation of an Electronic Decision Support Tool to improve Vascular Risk Management in patients with Diabetes Mellitus

Abstract

A growing diabetes pandemic is unfolding throughout the world. Cardiovascular disease is the major cause of mortality and morbidity in diabetes with huge associated economic burden. CVD risk factor management in patients with diabetes improves mortality and morbidity. In Australia, most opportunity for addressing CVD risk occurs within the primary health care system. Contemporary CVD risk management guidelines recommend basing the need for and intensity of prevention strategies on estimation of absolute risk. The proliferation of multiple disease specific guidelines, congested workflows, and implementation into time-pressured consultations pose critical barriers to guideline uptake into clinical practice in patients with diabetes. Clinical decision support systems are effective strategies to address these barriers. However, despite Australia’s burgeoning information technology health infrastructure, few such systems exist. In The Treatment Of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study the investigators utilised a multifaceted electronic decision support system and quality improvement intervention (‘HealthTracker’) to improve management of cardiovascular disease (CVD) risk. Data from TORPEDO presented in this thesis indicates that screening and treatment of cardiovascular risk factors in patients with diabetes remains suboptimal despite a number of quality incentive programs and government initiatives. As part of this thesis, the HealthTracker algorithm was expanded to include screening and management recommendations for patients with diabetes. This process was completed in 4 steps: (1) review of national and international guidelines; (2) development of an algorithm encompassing 178 guideline-based recommendations in concert with an expert advisory group; (3) validation and incorporation into an existing software platform interfacing with two of the most commonly used general practice record systems; (4) user acceptance testing with further modifications. Integrated disease management software tools such as HealthTracker hold promise to improve treatment gaps for patients with diabetes.