Monitoring Intensification of Treatment for Hyperglycemia and Hyperlipidemia

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DESCRIPTION (Provided by the Applicant): Diabetes quality-of-care measurement is increasingly being used to evaluate quality improvement programs and to compare physicians and health plans. It is therefore important to know which measures are best associated with clinical outcomes. The most widely used process measures of diabetes quality-of-care, A1C and LDL screening rates, have multiple limitations. This project will develop and validate 1) a new diabetes quality-of-care process measure and 2) the technology for monitoring that measure using analysis of the text of physician notes in the EMR. New Measure to be Developed: frequency of treatment intensification in the management of hyperglycemia and hyperlipidemia. In prior work we successfully developed a technique that allowed us to analyze the text of physician notes to identify anti-hypertensive treatment intensification. The measure derived from that work, frequency of antihypertensive treatment intensification, was strongly associated with blood pressure control. The objective of the current project is to extend this innovative approach to develop and validate a technique that could be used for ongoing measurement of treatment intensification in care of hyperglycemia and hyperlipidemia. Blood glucose and lipid control reduce diabetes complications. Nevertheless, recommended glucose and LDL levels are not achieved in the majority of patients. To improve care of diabetic patients, adherence to the process measures of diabetes care is increasingly monitored. However, the evidence that the currently used process measures are associated with improvement in diabetes outcomes is limited. It is therefore important to develop process measures of diabetes care that are strongly associated with outcomes. An increasingly recognized contributor to blood pressure, glucose and LDL control is that treatment for these conditions is rarely intensified during physician visits. Low frequency of treatment intensification has been linked to increased prevalence of elevated blood pressure and A1C. Furthermore, interventions aimed at increasing the frequency of treatment intensification have been demonstrated to lower A1C levels. Therefore a validated metric that evaluates intensification of treatment of hyperglycemia and hyperlipidemia could function as a process measure that provides a meaningful basis for clinicians to improve their outcomes. The gold standard for identifying treatment intensification currently is resource-intensive manual record review. This hinders widespread measurement of treatment intensification. Growing prevalence of electronic medical record systems that include computerized text of physician notes provides an opportunity for a novel approach to monitoring treatment intensification. In this project, we will expand the work we previously carried out in hypertension to develop and validate a technique that can be used for ongoing measurement of treatment intensification in care of hyperglycemia and hyperlipidemia in diabetic patients.