"Light-touch" diabetes intervention can be successfully integrated into clinical workflows

Background and goal: This study tested whether a referral order inside the Epic electronic health record (EHR) could help primary care clinicians refer patients to community-based diabetes prevention programs (DPPs), an important public health strategy to reduce incident type 2 diabetes, and whether patients enrolled after referral.

Study approach: A large health system in Michigan developed and implemented an order in their Epic EHR that allowed clinicians to refer patients to community-based DPPs offered by the National Kidney Foundation of Michigan, which then reached out to patients about nearby DPP classes. The researchers then reviewed 13 months of real-world use, looking at how many eligible patients were referred and enrolled, how many clinics and clinicians used the order, whether referrals met eligibility criteria, and whether referral activity was sustained over time.

Main results:

• Clinicians referred 577 patients to the diabetes prevention program. Of those, 21% (122 people) enrolled.

• Of the 350 primary care clinicians the project targeted, 30% (108) used the eReferral at least once.

• In total, 124 clinicians placed referrals. However, a small group of only 14 clinicians, accounted for over half of all referrals.

• Most of the referred patients met the program's eligibility rules (over age 18, BMI ≥25, and prediabetes or a history of gestational diabetes).

Why it matters: The study findings demonstrate that a "light-touch" intervention can be successfully integrated into clinical workflows, laying the groundwork for future adjustments and refinements to enhance its effectiveness.