Turning data into information: The use of new technologies to improve the delivery of healthcare for people with diabetes
Introduction: The rapid growth and maturation of Information technologies over recent decades has had a transformative effect on healthcare delivery. As our use of such systems increases, so too does the volume of routinely collected patient data. Accessing these data with a view to providing meaningful information to individuals remains a challenge. This thesis aims to assess the effectiveness of eHealth interventions that tailor information to users’ specific requirements; and describe the implementation and evaluation of a clinical decision support system (CDSS) for diabetes with a view to improving the care of those with diabetes. Methods: This study consisted of two phases. A systematic review was conducted for trials of tailored eHealth messaging in the management of chronic disease, assessing objectively measured clinical processes and outcomes. Following this, a CDSS for diabetes was developed and implemented within a diabetes electronic health record. The CDSS was evaluated via a mixed methods approach to assess user satisfaction and interaction with the system and to detect any changes in clinical processes and outcomes. Results: The systematic review identified 22 studies that met the eligibility criteria. There was limited evidence that tailored eHealth messaging was associated with improved clinical processes and outcomes, but study quality was poor. The CDSS was successfully implemented within the diabetes EHR with favourable feedback from users and evidence of improved efficiencies in working practices. Adherence to guidelines was markedly improved when compared to a closely matched control population. There was an observed small but significant improvement in glycaemic control and a decrease in progression of kidney disease. Conclusion: The ubiquitous nature of information technologies is testimony to the benefits that they bring to our everyday lives, including within the healthcare setting. This study has demonstrated that healthcare professionals (HCPs) caring for people with diabetes recognise the value of informatics in routine care via the use of a CDSS. This study has shown that a CDSS has the potential to improve clinical outcomes primarily by its effect on clinical processes i.e. adherence to guidelines. The diverse and complex nature of such technologies makes it difficult to assess the active component(s) effecting behaviour change. Ultimately, this limits generalisability into other settings. In this study, the active components of the CDSS can be identified as being improved efficiencies in working practices, whilst avoiding adverse effects on patient or user experience. It is tempting to infer that tailoring the CDSS messages to end-users (either patient or HCP) will improve outcomes further, however the existing evidence does not allow for this specific conclusion to be drawn. It is therefore imperative that future studies attempt to address this by recognising the complex nature of eHealth interventions and attempting to delineate the active component(s).
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