From Alert to Action: Electronic Practice Advisory Improves DSMES Referrals Over 18 Months.
Katrina E Donahue, Jacqueline R Halladay, Ping Chen et al.
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In 30 seconds
This cluster-randomized controlled trial in primary care practices in central North Carolina tested whether an electronic health record best practice advisory (BPA) increased referrals to diabetes self-management education and support (DSMES) for eligible patients with type 2 diabetes. Four practices used the BPA and two served as controls over 18 months; standing orders were added after 12 months to allow earlier deployment by nurses or medical assistants. Referral rates were 12.9% versus 1.2% at 12 months and 13.7% versus 1.6% at 18 months, favoring intervention clinics.
Key findings
- At 12 months, DSMES referral rates were 12.9% in BPA clinics and 1.2% in control clinics (P < 0.001).
- At 18 months, referral rates were 13.7% in intervention clinics and 1.6% in control clinics (P < 0.001).
- Adjusted odds of referral were higher in BPA-exposed clinics at 12 months (OR 10.55, 95% CI 4.65-23.94) and at 18 months (OR 9.44, 95% CI 4.91-18.17).
Why it matters
Referral to DSMES is an important step toward connecting people with type 2 diabetes to structured self-management support, yet engagement is often suboptimal. This trial suggests that embedding prompts in routine electronic workflows can increase referrals, with higher rates maintained after standing orders were introduced. The findings highlight a practical way to address a gap in referral processes, while measuring referrals rather than subsequent participation or health outcomes.
What to keep in mind
The trial involved six primary care practices in one region, and the reported outcome was referral rather than DSMES attendance or patient health outcomes.