Background and Aims : Medical groups have invested billions of dollars in outpatient Electronic Medical Records (EMR), but few studies demonstrate the cost-effectiveness of EMR-based clinical decision support. The aim of this study was to assess the cost-effectiveness of an EMR-based diabetes clinical decision support system on control of glycated hemoglobin (A1c), blood pressure (BP) and LDL-Cholesterol (LDL) in adults with diabetes based on results from a randomized clinical trial (RCT).
Methods : The RCT was conducted from October 2006 to May 2007 in Minnesota. Eleven clinics with 41 consenting primary care physicians (PCP) and these physicians’ 2556 diabetes patients were randomized either to receive or not to receive an EMR-based clinical decision support system designed to improve A1c, BP, and LDL in diabetes patients not at recommended clinical goals at the time of an office visit. A diabetes simulation model was used to estimate costs and quality of life years (QALYs) gained over a 40 year period from the health plan perspective.
Results : Intervention group PCPs used the EMR-based decision support system at 63% of all diabetes patient visits, and intensified drug therapy at 62% of visits with uncontrolled A1c. Intervention group diabetes patients had significantly lowered A1c (0.26%, p=.014) relative to patients of PCPs randomized to the control arm. The EMR-based decision support had a positive net cost of $280 (SE=207) in the first year. The cost per QALY was $22,000 over a 40-year period.
Conclusions : An EMR-based diabetes clinical decision support is a cost-effective approach to improve glucose control in adults with type 2 diabetes who were not at recommended clinical goals.