--- title: "Autopend decision spt to improve DM mgmt. | Sutter Health" description: "Automated pt.-centered decision support can improve monitoring of A1C among pts. with diabetes, particularly among patients who read reminders in timely manner." url: "https://www.sutterhealth.org/research/publications/autopend-decision-spt-to-improve-dm-mgmt-1055312391" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Autopend decision spt to improve DM mgmt. # Nudging physicians and patients with autopend clinical decision support to improve diabetes management. Panattoni L, Chan A, Yang Y, Olson C, & Tai-Seale M. _Am J Manag Care. 24(10):479-483._ 2018-10-01 ## Abstract OBJECTIVES: To determine the impact on routine glycated hemoglobin (A1C) laboratory test completion of incorporating an autopend laboratory order functionality into clinical decision support, which (1) routed provider alerts to a separate electronic folder, (2) automatically populated preauthorization forms, and (3) linked the timing and content of electronic patient health maintenance topic (HMT) reminders to the provider authorization. STUDY DESIGN: Observational pre-post study from November 2011 (1 year before autopend) through June 2014 (1.5 years after).METHODS: The study included HMT reminders concerning an A1C test for patients with type 1 or type 2 diabetes (N = 15,630 HMT reminders; 8792 patients) in a large multispecialty ambulatory healthcare system. A Cox proportional hazard model, adjusted for patient and provider demographics, estimated the likelihood of laboratory test completion based on 3 HMT reminder characteristics: preautopend versus postautopend period, read versus unread, and the patient's time to reading. RESULTS: In the postautopend period, the median time for patients to read reminders decreased (1 vs 3 days; P <.001) and the median time to complete laboratory tests decreased (40 vs 48 days; P <.001). Comparing preautopend HMT reminders with a similar time to reading, the likelihood of A1C laboratory test completion increased after autopend by between 21.1% (hazard ratio \[HR\], 1.211; P = .050), when time to reading was 57 days, and 33.9% (HR, 1.339; P = .003), when time to reading was 0 days. This result included 68% of the reminders. There was no statistical difference in A1C laboratory test completion for unread reminders in the preautopend versus postautopend period. CONCLUSIONS: Automated patient-centered decision support can improve guideline-concordant monitoring of A1C among patients with diabetes, particularly among patients who read reminders in a timely fashion. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/30325190) ## Research topics - [Diabetes, Insulin Resistance and Metabolic Syndrome](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.](https://www.sutterhealth.org/research/publications/initiation-tx-incident-diabetes-ehrs-primary-care-1055312897) Chung S, Zhao B, Lauderdale D, Linde R, Stafford R, Palaniappan L. Prim Care Diabetes. 9(1):23-30. doi: 10.1016/j.pcd.2014.04.005. Epub 2014 May 5. 2015 Feb 01 - Publication ### [CM-SHARE: Development, integration, and adoption of an electronic health record-linked digital health solution to support care for diabetes in primary care.](https://www.sutterhealth.org/research/publications/ehr-linked-app-to-support-diabetes-care-in-primary-care-1055312811) Jones JB, Liang S, Husby HM, Delatorre-Reimer JK, Mosser CA, Hudnut AG, Knobel K, MacDonald K, Yan XS. Clin Diabetes. 37(4):338-346. doi: 10.2337/cd18-0057. 2019 Oct 01 - Publication ### [Can secure patient-provider messaging improve diabetes care?](https://www.sutterhealth.org/research/publications/secure-pt-provider-messaging-improve-diabetes-care-1055312308) Chung S, Panattoni L, Chi J, Palaniappan L. Diabetes Care. pii: dc170140. doi: 10.2337/dc17-0140. \[Epub ahead of print\] 2017 Aug 14 - Publication ### [Impact of education on weight in newly diagnosed type 2 diabetes: every little bit helps.](https://www.sutterhealth.org/research/publications/education-impact-wt-diabetes-1055312810) Azar KM, Chung S, Wang EJ, Zhao B, Linde RB, Lederer J, Palaniappan LP. PLoS One. 10(6):e0129348. doi: 10.1371/journal.pone.0129348. eCollection 2015. 2015 Jun 08 - Publication ### [Cost estimates for designing and implementing a novel team care model for chronically ill patients.](https://www.sutterhealth.org/research/publications/cost-estimates-to-design-implement-chronic-care-model-1055312334) Panattoni L, Dillon E, Hurlimann L, Durbin M, Tai-Seale M. J Ambul Care Manage. doi: 10.1097/JAC.0000000000000209. \[Epub ahead of print\] 2017 Sep 25 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/autopend-decision-spt-to-improve-dm-mgmt-1055312391#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Autopend decision spt to improve DM mgmt."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/autopend-decision-spt-to-improve-dm-mgmt-1055312391#medicalscholarlyarticle","name":"Nudging physicians and patients with autopend clinical decision support to improve diabetes management.","headline":"Autopend decision spt to improve DM mgmt.","abstract":"OBJECTIVES: To determine the impact on routine glycated hemoglobin (A1C) laboratory test completion of incorporating an autopend laboratory order functionality into clinical decision support, which (1) routed provider alerts to a separate electronic folder, (2) automatically populated preauthorization forms, and (3) linked the timing and content of electronic patient health maintenance topic (HMT) reminders to the provider authorization. STUDY DESIGN: Observational pre-post study from November 2011 (1 year before autopend) through June 2014 (1.5 years after).METHODS: The study included HMT reminders concerning an A1C test for patients with type 1 or type 2 diabetes (N = 15,630 HMT reminders; 8792 patients) in a large multispecialty ambulatory healthcare system. A Cox proportional hazard model, adjusted for patient and provider demographics, estimated the likelihood of laboratory test completion based on 3 HMT reminder characteristics: preautopend versus postautopend period, read versus unread, and the patient's time to reading. RESULTS: In the postautopend period, the median time for patients to read reminders decreased (1 vs 3 days; P \u003c.001) and the median time to complete laboratory tests decreased (40 vs 48 days; P \u003c.001). Comparing preautopend HMT reminders with a similar time to reading, the likelihood of A1C laboratory test completion increased after autopend by between 21.1% (hazard ratio [HR], 1.211; P = .050), when time to reading was 57 days, and 33.9% (HR, 1.339; P = .003), when time to reading was 0 days. This result included 68% of the reminders. There was no statistical difference in A1C laboratory test completion for unread reminders in the preautopend versus postautopend period. CONCLUSIONS: Automated patient-centered decision support can improve guideline-concordant monitoring of A1C among patients with diabetes, particularly among patients who read reminders in a timely fashion.","description":"Automated pt.-centered decision support can improve monitoring of A1C among pts. with diabetes, particularly among patients who read reminders in timely manner.","keywords":["Diabetes, Insulin Resistance and Metabolic Syndrome","Disease Management","Medical Informatics"],"datePublished":"2018-10-01","url":"https://www.sutterhealth.org/research/publications/autopend-decision-spt-to-improve-dm-mgmt-1055312391","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"30325190"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/30325190/"],"isPartOf":{"@type":"Periodical","name":"Am J Manag Care"},"author":[{"@type":"Person","name":"Panattoni L"},{"@type":"Person","name":"Chan A"},{"@type":"Person","name":"Yang Y"},{"@type":"Person","name":"Olson C"},{"@type":"Person","name":"Tai-Seale M"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Diabetes, Insulin Resistance and Metabolic Syndrome","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/autopend-decision-spt-to-improve-dm-mgmt-1055312391","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/autopend-decision-spt-to-improve-dm-mgmt-1055312391#breadcrumblist"}}} ```