Estenda Solutions, a leading healthcare technology research company specializing in disease management and population health software, announced the official launch of the company’s signature product the Comprehensive Disease Management Program. CDMP is a complete customizable web-based clinical application for the management of patients with diabetes and other chronic conditions.

The Use of a Comprehensive Diabetes Management Program (CDMP) Enhanced by a Computer-Assisted Decision Support System to Improve Outcomes in Patients with Type 2 Diabetes Mellitus Who Are Treated by Primary Care Providers.

Abstract An EHR alone is not sufficient for a physician practice to embrace the Patient Centered Medical Home (PCMH) model. Numerous components including the ability to securely communication with your patients, clinical decision support, and capturing and reporting on quality measures are integral to the PCMH model. The Comprehensive Disease Management Platform (CDMP) has evolved over time originally developed in support of the Chronic Care Model; it now supports the Patient Centered Medical Home. CDMP’s background and history of use in support of PCMH will be discussed along with its integration with the EHR.   Show more...

Abstract Behaviors carried out by the person with diabetes (e.g., healthy eating, physical activity, judicious use of medication, glucose monitoring, coping and problem-solving, regular clinic visits, etc.) are of central importance in diabetes management. To assist with these behaviors, we developed a prototype PHA for diabetes self-management that was based on User-Centered Design principles and congruent with the anticipatory vision of Project Health Design (PHD). This article presents aspects of the prototype PHA’s functionality as conceived under PHD and describes modifications to the PHA now being under- taken under new sponsorship, in response to user feedback and timing tests we have performed. In brief, the prototype Personal Health Application (PHA) receives data on the major diabetes management domains from a Personal Health Record (PHR) and analyzes and provides feedback based on clinically vetted educational content. The information is presented within gadgets within a portal-based website. The PHR used for the first implementation was the Common Platform developed by PHD. Key changes include a re-conceptualization of the gadgets by topic areas originally defined by the American Associa- tion of Diabetes Educators, a refocusing on low-cost approaches to diabetes monitoring and data entry, and synchronization with a new PHR, Microsoft HealthVault™.   Show more...

Background and aims: The increasing number of options for therapy and the failure of most patients to achieve A1C goals in a timely manner suggest the need for clinical decision support at the point of care. We sought to develop a customizable software system that could provide advice to primary care physicians at the point of care, providing recommendations and explanations.
Materials and methods: We have developed a computer-assisted decision support (CADS) system with customizable modules for patient, provider, and administrator. CADS is based on extensive statistical analysis and graphical displays of uploaded glucose data (SMBG); medication history; individualized glycemic goals; analysis of laboratory data (A1C, renal and hepatic function); and co-morbidities (cardiac, renal, hepatic, gastrointestinal). The software provides a concise report to the clinician regarding overall quality of glycemic control and identifies problems such as hypo- and hyperglycemia, excessive variability, insufficient glucose monitoring, and presence of various patterns. A rule-based expert system then makes recommendations to adjust dosage of current medications, discontinue medications, add new medications, or change the treatment regimen. We have constructed algorithms with recommended sequences for 61 regimens, including therapeutic lifestyle changes, 8 forms of monotherapy, 22 forms of dual therapy, and 30 forms of triple therapy utilizing 8 classes of medications: metformin, DPP-4 inhibitors, GLP-1 analogs, thiazolidenediones, sulfonylureas and glinides, alpha-glucosidase inhibitors, and basal insulins. Treatment pathways can be customized by the individual physician or clinic. The algorithm considers pharmacodynamics as well as relative and absolute contraindications, and offers alternatives and options. The user can override the program's recommendations and can readily access brief or detailed prescribing information, clinical practice guidelines, or the medical literature. The logic of the program can be modified using a series of tables, without the need for reprogramming.
Results: A prototype system has been constructed, tested with real and synthetic data, and found to perform well. The program analyzes SMBG data, identifies problems (hypoglycemia, hyperglycemia, variability, or insufficient glucose data) and recommends adjustment of dosages, addition or discontinuation of medications. The program provides caveats appropriate to each case. Extensive safety testing has been performed. The recommendations of the program are consistent with the judgment of highly experienced endocrinologists in a large series of test cases. The software has been integrated with a Comprehensive Diabetes Management Program that provides reminders and alerts and interfaces with an electronic medical record. The program can also operate in a stand alone mode with manual entry of laboratory data and medication history.
Conclusion: This study demonstrates that computer assisted clinical decision support is feasible. The logic of the program can be custom tailored to the preferences of individual clinics and physicians.
Authors: D. Rodbard, Clinical Research and Medical Informatics, Biomedical Informatics Consultants LLC, Potomac, R.A. Vigersky, Diabetes Institute, Walter Reed Army Medical Center, Washington, USA.   Show more...

Dr. Garry Welch from Baystate Medical Center in Springfield, MA presented a poster titled "A Brief Intervention Using a Web-based Patient Self Management Assessment Tool Improves Blood Glucose Control (HbA1c)" at the 2009 American Diabetes Association Meeting. In this poster, Dr. Welch describes and presents his research using the Comprehensive Diabetes Management Program (CDMP) and the embedded survey called the Diabetes Self-Care Profile (DSCP). His research demonstrated the effectiveness of using the DSCP in improving patient's A1C.  Show more...

Abstract The Comprehensive Diabetes Management Program (CDMP) is a web-based diabetes medical informatics tool developed by a consortium of researchers, physicians, and educators specializing in diabetes and its management. The overall goal behind the development of the CDMP is to provide an interactive, web-based clinical tool for care managers to efficiently manage and coordinate appropriate care for diabetic patients and to encourage patient behavior changes. The CDMP focuses on patient behavior change as the catalyst for improved outcomes. To achieve this goal, CDMP has two very distinct user interfaces: the first for providers and care managers (referred to as CDMP) and the second for direct patient access which incorporates the CDMP patient access portal (referred to as DMEverywhere). The CDMP is being used in 12 organizations and data are currently being collected for studies of clinical efficacy and cost efficiency.   Show more...

Abstract Several studies suggest that telehealth eye care programs that combine retinal imaging, edu- cation, and some care management can improve patient adherence to annual, comprehensive eye examinations and follow-up treatments. Little is known, however, about whether such programs relate to other, more distal outcomes that affect diabetic eye disease, such as blood glucose control. This paper assesses the relationship of participation in a diabetes telehealth eye care program with standard, face-to-face eye care as well as improvements in other diabetes-related health outcomes. We conducted a retrospective study using data from electronic medical records of Joslin Diabetes Center (n = 13,752). The data span 2 years: baseline and follow-up. Subjects’ eye care groups were no eye care, eye care outside of the clinic, standard eye care at the clinic, or participation in the Joslin Vision Network telehealth eye care program. We analyzed the relationship of participation in the telehealth eye care program at baseline to follow-up eye care groups and changes in hemoglobin A1c, low density lipoprotein levels, and systolic blood pressure. The results show that participation in the telehealth eye care program was significantly correlated with whether subjects later obtained standard eye care, improvement in hemoglobin A1c, and improvement in low density lipoprotein. Thus, telehealth eye care programs that incorporate evaluation, education, and care planning are related to use of recommended eye care and improvements in certain diabetes-related health outcomes. Such programs can address the many aspects of care necessary to reduce risk of vision loss due to diabetic retinopathy and other diabetes-related complications. Future research might test hypotheses suggested by sociological and psychological theories regarding causa- tion between participation in a telehealth eye care program and other diabetes care.   Show more...

Abstract We piloted a culturally sensitive diabetes case management tool (Comprehensive Diabetes Management Program, CDMP) based on the Chronic Care Model in an urban community health center. Self management support included use of the Diabetes Sel Care Profile (DSCP), a web-based diabetes self management assessment program. The CDMP provides standard clinical algorithms, clinical decision support, treatment guide- lines with customizable alerts, and reminders. The CDMP integrates the Joslin Vision Network eye screening telemedicine system and its nonmydriatic (non-dilated eye) cam- era, and standardized retinopathy reading at the Joslin Diabetes Center, Boston, Ma. PCPs receive a regular summary report of the CDMP findings from study case managers to sup- port practice guideline adherence. Forty eligible patients (Hispanic, Type 2, poor bg con- trol with A1c 7.5% or higher) were randomized to case management intervention (CMI) or attention control (AC).The sample was 67% female, mean age 57 yrs., 61% had dia- betes >10 years. In year prior to randomization, 40% had >=1 ER visit, 35% a foot exam 23% an eye exam. CMI patients received 6 individual 1 hour visits to the CMI team (Hispanic diabetes nurse and dietitian) over one year. We report here 6 month findings only. Attention control received 6 individual visits with lay clinic staff trained to discuss standardized diabetes education materials. Results showed that HbA1c was significantly lowered for the CMI group as compared to AC (-1.2%±1.4 vs.-0.07%±1.0, p<0.02). Systolic and diastolic blood pressure were also significantly lowered for CMI (both p<0.02). Yield for the JVN eye screening showed 26.3% of CMI pts. required treatment follow-up for retinopathy or macular edema. DSCP results showed 87.5% of CMI pts. reported one or more psychosocial barriers at baseline. High diabetes emotional distress (Problem Areas In Diabetes, PAID score >=50) was found for 66.6%, major depression (using PHQ) for 52.3%, hypglycemia for 57.1%, binge eating for 28.6%, low social sup- port for 23.8%, and alcohol abuse (using CAGE) 0%. PAID change scores were signifi- cantly lowered (improved) for CMI (-11.8± 24.8) and increased for AC(+4.4 ±21.2)(p<0.03). Overall, our 6 month CDMP pilot data showed improved clinical and psychosocial outcomes, successfully identified pts.requiring treatment for retinopathy and identified a high proportion of pts.with psychosocial barriers to self management.   Show more...