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.
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.


METHODS
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.


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


METHODS
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.
Libby
Anne M
AM
University of Colorado School of Pharmacy, Denver, CO, USA. anne.libby@ucdenver.edu
Pace
Wilson
W
Bryan
Cathy
C
Anderson
Heather Orton
HO
Ellis
Samuel L
SL
Allen
Richard Read
RR
Brandt
Elias
E
Huebschmann
Amy G
AG
West
David
D
Valuck
Robert J
RJ
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D057186:Comparative Effectiveness Research / Q000379:methods*; D003195:Computer Communication Networks; D003625:Data Collection / Q000379:methods; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007223:Infant; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000627:therapeutic use*; D010865:Pilot Projects; D028321:Plant Preparations / Q000627:therapeutic use*; D019095:Point-of-Care Systems; D011320:Primary Health Care; D011446:Prospective Studies
D007004:Hypoglycemic Agents; D004366:Nonprescription Drugs; D028321:Plant Preparations