Compared with team-based care alone, the use of a clinical decision support system (CDSS) with team-based care produced significant but modest reductions in the risk of cardiovascular disease (CVD) in patients with uncontrolled type 2 diabetes and comorbid conditions, according to a study of 11,132 people at 38 Chinese community health centers. “Integrating team-based care with a computerized CDSS could be especially appropriate in primary care settings in [low- and middle-income countries (LMICs)], where providers might not have sufficient training in diabetes care,” conclude the D4C (Diabetes Complication Control in Community Clinics) trial investigators. “These findings support widespread adoption of this implementation strategy in community primary care settings in China and other LMICs to reduce CVD risk among patients with diabetes.”
Teams included primary care physicians and health coaches (nurses certified after training in behavioral interventions on nutrition, lifestyle changes, and medication adherence) in the primary care setting and diabetes specialists at tertiary hospitals. Coprimary outcomes were the mean reductions in hemoglobin A1c (HbA1c) level, LDL cholesterol (LDL-C) level, and systolic blood pressure (BP) over 18 months and the proportion of participants with all 3 risk factors controlled at 18 months.
Levels of all 3 factors decreased significantly at 18 months with CDSS-supported team-based care, but the net differences compared with team-based care alone were small: −0.2 percentage point (95% CI, −0.3 to −0.1 percentage point) for HbA1c level, −6.5 mg/dL (−8.3 to −4.6 mg/dL) for LDL-C level, and −1.5 mm Hg (CI, −2.8 to −0.3 mm Hg) for systolic BP. With team-based care plus CDSS, the proportion of patients with all 3 risk factors controlled was 16.9% (CI, 15.7% to 18.2%) compared with 13.0% (CI, 11.7% to 14.3%) for team-based care alone.