The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study

Purpose To determine the impact of a physiciandirected, multifaceted health information technology (HIT) system on diabetes outcomes. Methods A pre/post-interventional study. Setting and participants The setting was Providence Primary Care Research Network in Oregon, with approximately 71 physicians caring for 117 369 patients in 13 clinic locations. The study covered Network patients with diabetes age 18 years and older. Intervention The study intervention included implementation of the CareManagerTM HIT system which augments an electronic medical record (EMR) by automating physician driven quality improvement interventions, including point-of-care decision support and care reminders, diabetes registry with care prompts, performance feedback with benchmarking and access to published evidence and patient educational materials. Measures The primary clinical measures included the change in mean value for low density lipoprotein (LDL) target <100 mg/dL or 2.6 mmol/l, blood pressure (BP) target <130/80 mmHg and glycated haemoglobin (HbA1c) target <7%, and the proportion of patients meeting guideline-recommended targets for those measures. All measures were analysed using closed and open cohort approaches. Results A total of 6072 patients were identified at baseline, 70% of whom were continuously enrolled during the 24-month study. Significant improvements were observed in all diabetes related outcomes except mean HbA1c. LDL goal attainment improved from 32% to 56% (P=0.002), while mean LDL decreased by 13 mg/dL (0.33 mmol/l, P=0.002). BP goal attainment increased significantly from 30% to 52%, with significant decreases in both mean systolic and diastolic BP. The proportion of patients with an HbA1c below 7% was higher at the end of the study (P=0.008). Mean patient satisfaction remained high, with no significant difference between baseline and follow-up. Total Relative Value Units per patient per year significantly increased as a result of an increase in the number of visits in year one and the coding complexity throughout. Conclusion Implementation of a physician-directed, multifaceted HIT system in primary care was associated with significantly improved diabetes process and outcome measures

Empowering faculty to initiate STEM education transformation: Efficacy of a systems thinking approach

Just a decade ago Vision and Change in Undergraduate Biology Education: A Call to Action was released, catalyzing several initiatives to transform undergraduate life sciences education. Among these was the Partnership for Undergraduate Life Sciences Education (PULSE), a national organization commissioned to increase the adoption of Vision and Change recommendations within academic life sciences departments. PULSE activities have been designed based on the recognition that life sciences departments and faculty are embedded within institutions of higher education which, similar to other large organizations, are complex systems composed of multiple, interconnected subsystems. The organizational change research suggests that effecting large-scale changes (e.g., undergraduate STEM education transformation) may be facilitated by applying systems thinking to change efforts. In this paper we introduce the approach of systems thinking as a professional development tool to empower individual STEM faculty to effect department-level transformation. We briefly describe a professional development experience designed to increase life sciences faculty members’ understanding of systems thinking, present evidence that faculty applied a systems thinking approach to initiate department-level change, and discuss the degree to which transformation efforts were perceived to be successful. Though focused on faculty in the life sciences, our findings are broadly transferable to other efforts seeking to effect change in undergraduate STEM education