Minnesota delivery systems HealthPartners and Essentia Health are teaming to use clinical decision support systems to identify patients with prediabetes and at risk for getting sicker.

Twin Cities-based HealthPartners and Duluth-based Essentia both have sizable health systems in the state and also serve parts of adjoining or nearby states. However, they serve distinctly different regions and do not consider each other as competitors, says Jay Desai, a research fellow at HealthPartners’ Institute for Education and Research, which is conducting the project along with the Essentia Institute of Rural Health.

Individuals with prediabetes have elevated blood sugar levels that are not high enough to be classified as Type 2 diabetes, but 15 percent to 30 percent of them will develop the disease within five years if there is no intervention, according to the organizations.

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The five-year study is funded with a $3.7 million grant from the National Heart, Lung and Blood Institute. Researchers expect 17,000 Essentia patients with prediabetes to be part of the program and receive care in at least 30 Essentia primary care clinics in northern Minnesota, northwest Wisconsin and eastern North Dakota.

A homegrown clinical decision support system (CDS) at HealthPartners has been pulling data from the electronic health records system and running it through a rules engine to aid in controlling patients with diabetes and cardiovascular disease for several years, with success in lowering glucose and blood pressure levels, says Patrick O’Connor, M.D., a senior clinical research investigator at the HealthPartners Institute for Education and Research. Now, the CDS is being modified to identify patients with prediabetes and provide them and their doctors with personalized care recommendations.

In addition to blood pressure and glucose levels, the CDS will identify other factors that can influence the health status of patients with prediabetes, such as smoking, aspirin use and lipids. The system will collect and analyze data in real time when the patient is in the office to educate the patient and enable the doctor to immediately recommend evidence-based recommendations.

“The same information is given to you and the doctor to look at possible treatments,” O’Connor says. “It’s really designed to support patient-centered care and to help them make informed decisions in their own care.” And because these patients will be seen four to six times a year, patients and doctors can track progress or set-backs, he adds.

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