Introduction & Objective: DSMES is underutilized by people with Type 2 diabetes (T2D), in part due to low rates of referral by health care providers. We sought to determine if rates of referral to DSMES increase through the use of a BPA deployed during clinic visits to health care providers via the electronic health record.
Methods: In this randomized controlled trial in central North Carolina, we created a BPA within the Epic electronic health record that fired when a patient with T2D who qualified for DSMES attended a routine visit with their primary care provider. The BPA was deployed in four primary care practices within a large, university-based health care system. Two additional practices served as controls and did not receive the intervention. We conducted multilevel binary logistic regressions with patient data nested within the provider, using the indicator of the intervention (vs. control clinics) as the predictor to estimate the odds ratio of provider referring an eligible patient to DSMES services after a patient encounter. Clinic-level (percentages of patients with Medicare and Medicaid use) and patient-level (age, sex, and race) variables were controlled in the adjusted model.
Results: Between April and October 2023, 1,326 BPAs fired in the intervention clinics resulting in an 11% referral rate to DSMES. Control clinics had 938 patient visits that qualified for DSMES referral with a 4% referral rate of eligible patients to DSMES. The 7% increase in referral rate between the intervention and control practices is statistically significant (p<0.001). In the adjusted multivariate model, controlling for the covariates, patients who are in the intervention clinics with BPA firing have significantly higher odds of being referred for DSMES services than those who are in the control clinics without BPA firing (OR = 4.19 [95% CI 2.63-6.67], p < 0.001).
Conclusions: Electronic BPAs do significantly increase patient referrals to DSMES services.
L.A. Young: Research Support; Novo Nordisk, Eli Lilly and Company, vTv Therapeutics, Beta Bionics, Inc., Corcept Therapeutics, Rhythm Pharmaceuticals, Inc., Bayer Inc., Jaeb Center for Health Research. J. Halladay: None. P. Chen: None. K.M. Mottus: None. K.K. Goeke-Austin: None. E.L. Richman: None. J. Rees: None. K. Donahue: None.
