SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM)
The overall goal of this project is to develop a comprehensive, longitudinal clinical registry of a population of approximately 1.3 million insured patients with diabetes mellitus and a similar database of all members without diabetes from 11 integrated health care delivery systems. The registry will cover the period from 2005-2013, draw from demographic and clinical data elements in EHRs and other system databases, capture patient-reported data where it is already being routinely collected, and calculate and add data on medication adherence. For more information, visit www.supreme-dm.org.
ARRA-CER Grant Type: The Prospective Outcome Systems using Patient-specific Electronic data to Compare Tests and therapies (PROSPECT) Studies
Create a comprehensive, standardized diabetes registry across the 11 health care systems and utilize this for conducting surveillance (identify and monitor trends in diabetes incidence and prevalence, and in diabetes treatment patterns and outcomes).
|Informatics Platform/Tools: The DataLink effort has created diabetes registries at each site using their respective virtual data warehouses (VDWs). Each site in the HMO Research Network maintains a standardized VDW research database that consists of retrospective enrollment, demographic, utilization, pharmacy, lab, mortality, and vital signs tables. These tables may be in Oracle, SQL, or SAS formats, but are structured in a way that centrally created SAS programs can be distributed to all sites and run against their data. The NLP Core uses software called "MediClass" to search for key words and phrases in electronic medical record progress notes to find evidence of obesity counseling and medical non-adherence. The NLP process can take information from the medical record and transform it into structured data variables that lend themselves to statistical analysis.
|Data Storage: Distributed Research Network-- Site data retained and warehoused at each of the 11 participating sites.
- Use the data infrastructure to develop a comprehensive, longitudinal clinical registry of a population of patients with diabetes and to conduct surveillance and identify and monitor trends in diabetes mellitus, gestational diabetes mellitus, and pre-diabetes incidence and prevalence, and in diabetes treatment patterns and outcomes;
- Conduct a trial to evaluate the effectiveness of providing brief adherence counseling on “early nonadherence” with newly-prescribed medications; and
- Conduct an observational study of women with recent GDM who have an abnormal postpartum glucose test to understand the effectiveness of various communication, counseling and referral strategies.
- Treatment Core Study: A multi-system, cluster-randomized CER intervention that uses the standardized registries to rapidly identify patients in 4 centers who have DM with uncontrolled CVD risk factors (A1c, LDL-c or SBP) with newly prescribed anti-diabetic, antihypertensive, and lipid-lowering (cardio-metabolic) medications and provides tools and strategies to address early non-adherence to clinical outreach staff.
- Prevention of Diabetes Core Study: Observational CER cohort study in 3 centers of women with a recent pregnancy during which they developed gestational diabetes mellitus (GDM) to understand the effectiveness of follow-up approaches including postpartum glucose testing and communication, counseling, and referral strategies, in the prevention of type 2 diabetes mellitus.
- NLP Prevention and Treatment Studies: Develop two software applications to assess the use of behavioral counseling for medications adherence and for weight loss in GDM.
Partner Types: 11 HMOs (contributing data); 3 academic institutions (not contributing data)
|Estimated Network Population Size: 1.3 million diabetes patients
|Geographic Area: Honolulu, HI; Seattle, WA; Portland, OR; Northern CA (Oakland); Southern CA (Pasadena); Denver, CO; Minneapolis, MN; Marshfield, WI; Detroit, MI; Atlanta, GA; Danville, PA; Tel Aviv, Israel
John F. Steiner, M.D., M.P.H.
Institute for Health Research
Kaiser Permanente Colorado
Dr. Steiner is the Senior Director of Institute for Health Research at Kaiser Permanente Colorado as well as a professor of general internal medicine at the University of Colorado School of Medicine. He is currently the vice-chairman of the HMO Research Network Governing Board and recently completed his 4-year term as chair of the Health Systems Research study section for the Agency for Healthcare Research and Quality (AHRQ). His research interests include access to care, health disparities, prevention of cardiovascular disease and treatment adherence.
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Institute for Health Research, Kaiser Permanente Colorado (Denver, CO)
Build a national research network and multisystem distributed database (DataLink) that captures and standardizes detailed demographic and longitudinal electronic clinical data for conducting CER and surveillance in the treatment and prevention of diabetes mellitus.
CER Study Priority Conditions
- Diabetes Mellitus including Type 1, Type 2, and pre-Diabetes
- Pregnancy, with a focus on women with gestational diabetes
- Heart and blood vessel conditions
CER Study Priority Populations
- Pregnant Women
- Low-income groups
- Minority Groups
- Individuals who live in inner-city areas
- Individuals who live in rural areas
- Individuals who need chronic care
CER Studies--Outcome(s) of Interest
- Treatment Core Study: To understand the effectiveness of strategies to address early non-adherence and assess if the intervention leads to improved adherence and, in turn improved control of hemoglobin A1c, blood pressure, and LDL-cholesterol
- Prevention of Diabetes Core Study: To understand the effectiveness of follow up approaches including postpartum glucose testing and communication, counseling, and referral strategies, in the prevention of T2DM. The primary outcome is weight at 12 months after delivery in relation to their pre-pregnancy weight and body mass index since overweight/ obesity is a major risk factor for developing T2DM
- NLP Prevention and Treatment Studies: Findings will be examined as potential mediators or modifiers of treatment effectiveness
Study Population Size
1.3 million eligible members in health plan with diabetes
All healthcare settings
Kaiser Permanente Colorado (lead site); Geisinger Health System; Group Health Cooperative; Henry Ford Health System; HealthPartners; Kaiser Permanente Hawaii; Kaiser Permanente Northern California; Kaiser Permanente Northwest; Kaiser Permanente Southern California; Kaiser Permanente Southeast; Marshfield Clinic; Johns Hopkins University; (not contributing data) University of Michigan
Project Resources & Products