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Providing diabetes patients all of the care recommended by current guidelines is a clinical challenge. Geisinger Health System has designed a provider-led, team-based system of care to more consistently and reliably meet this challenge. This system of care uses an all-or-none bundle of diabetes measures and electronic health record tools to improve both process measures and intermediate diabetes outcomes.
There is growing recognition and expectation that electronic health records (EHRs) can be used to facilitate patient care and, in particular, management of patients with multimorbid conditions. Diabetes, an increasingly common disease among primary care patients, poses many care management challenges. Diabetes among older patients in particular is often associated with numerous other chronic conditions. The American Diabetes Association (ADA) and other organizations have published detailed, evidence-based recommendations for effective management of patient outcomes, including medical care from a physician-coordinated team.1 However, the provision of state-of-the-art guideline care is rarely achieved.2 At Geisinger Health System (GHS) in Danville, Pa., we developed a bundled protocol for primary care physicians (PCPs) to facilitate the delivery of such care.
Providing guideline-based care is challenging, especially for PCPs. Each day, PCPs see patients with diverse medical conditions. Although published evidence-based guidelines exist for many of these conditions, it is impossible for PCPs to stay current with all guidelines, to recall the specific guidelines that are relevant to each patient, and to act on all relevant guidelines.
Evidence supports this gap. For example, one study showed that only 54.9% of recommendations actually were provided to adults in the United States.3 One reason for the gap in care is the time required to fulfill all recommended guidelines. Providing just the recommendations for chronic medical conditions to a panel of 2,500 patients each year would take 10.6 hours of each working day.4 An additional 7.4 hours per day would be required for preventive recommendations, and 4.6 hours per day would be needed for providing acute care.5'6 Clearly, this cannot be the work of one physician; a team-based model of care that functions in a reliable and accountable manner is required.
Delivering guideline-based care is especially challenging for patients with multi-morbid conditions, for whom expert knowledge on several conditions and a coordinated team-based approach is recommended.7 EHRs can be used to facilitate a...