title: 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.
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.
  
  
  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.
authors.affiliation: University of Colorado School of Pharmacy, Denver, CO, USA. anne.libby@ucdenver.edu
authors.forename: Anne M
authors.initials: AM
authors.lastname: Libby
authors.forename: Wilson
authors.initials: W
authors.lastname: Pace
authors.forename: Cathy
authors.initials: C
authors.lastname: Bryan
authors.forename: Heather Orton
authors.initials: HO
authors.lastname: Anderson
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Ellis
authors.forename: Richard Read
authors.initials: RR
authors.lastname: Allen
authors.forename: Elias
authors.initials: E
authors.lastname: Brandt
authors.forename: Amy G
authors.initials: AG
authors.lastname: Huebschmann
authors.forename: David
authors.initials: D
authors.lastname: West
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Valuck
mesh_terms: 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
chemical_list: D007004:Hypoglycemic Agents; D004366:Nonprescription Drugs; D028321:Plant Preparations