Comparative Effectiveness Research in DARTNet Primary Care Practices: Point of Care Data Collection on Hypoglycemia and Over-The-Counter and Herbal Use Among Patients Diagnosed With Diabetes

Med Care. 2010 Jun;48(6 Suppl):S39-44. doi: 10.1097/MLR.0b013e3181ddc7b0.

Abstract

Background: The Distributed Ambulatory Research in Therapeutics Network (DARTNet) is a federated network of electronic health record (EHR) data, designed as a platform for next-generation comparative effectiveness research in real-world settings. DARTNet links information from nonintegrated primary care clinics that use EHRs to deliver ambulatory care to overcome limitations with traditional observational research.

Objective: Test the ability to conduct a remote, electronic point of care study in DARTNet practices by prompting clinic staff to obtain specific information during a patient encounter.

Research design: Prospective survey of patients identified through queries of clinical data repositories in federated network organizations. On patient visit, survey is triggered and data are relinked to the EHR, de-identified, and copied for evaluation.

Subjects: Adult patients diagnosed with diabetes mellitus that scheduled a clinic visit for any reason in a 2-week period in DARTNet primary care practices.

Measures: Survey on hypoglycemic events (past month) and over-the-counter and herbal supplement use.

Results: DARTNet facilitated point of care data collection triggered by an electronic prompt for additional information at a patient visit. More than one-third of respondents (33% response rate) reported either mild (45%) or severe hypoglycemic events (5%) in the month before the survey; only 3 of those were also coded using the ICD-9 (a significant difference in detection rates 37% vs. 1%). Nearly one-quarter of patients reported taking an OTC/herbal, 4% specifically for the treatment of symptoms of diabetes.

Conclusions: Prospective data collection is feasible in DARTNet and can enable comparative effectiveness and safety research.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Comparative Effectiveness Research / methods*
  • Computer Communication Networks
  • Data Collection / methods
  • Diabetes Mellitus / drug therapy*
  • Female
  • Humans
  • Hypoglycemia / chemically induced*
  • Hypoglycemic Agents / adverse effects*
  • Infant
  • Male
  • Middle Aged
  • Nonprescription Drugs / therapeutic use*
  • Pilot Projects
  • Plant Preparations / therapeutic use*
  • Point-of-Care Systems*
  • Primary Health Care
  • Prospective Studies

Substances

  • Hypoglycemic Agents
  • Nonprescription Drugs
  • Plant Preparations