Over 30 million people in the United States have diabetes, and more than 84 million adults have prediabetes, according to the CDC. Screening patients to identify undiagnosed diabetes or prediabetes can help patients get treatment sooner. Henry Ford Health System helps patients establish healthy habits and avoid diabetes by identifying patients with prediabetes using screenings in Epic. In one year, they identified nearly 4,700 patients who were potentially prediabetic.
Clinicians use Epic to monitor prediabetes patients and quickly order lab tests or other maintenance care. If a patient is a candidate for the National Diabetes Prevention Program, which provides additional coaching for prediabetes patients, clinicians are prompted to order a referral for the patient. During office visits, clinicians are reminded to follow up with patients who are at risk or due for preventive care.
Henry Ford has referred nearly 300 patients to DPP, and more than two-thirds of those patients chose to enroll in the program, a significantly higher enrollment rate than the DPP’s other referral sources. In addition, they saw improved weight-loss outcomes for patients enrolled in DPP.
“Once [DPP] started receiving referrals from the clinical side, outcomes improved,” said Dr. Kate Kirley, director of chronic disease prevention in the Improving Health Outcomes group at the AMA. “It suggests that there is something about clinicians being involved in making the referral that is making a difference.”