From Alert to Action: Electronic Practice Advisory Improves DSMES Referrals Over 18 Months
In brief
Electronic alert raises DSMES referrals to 13% versus 1.5% in controls
In a cluster-randomized trial, an electronic best-practice advisory prompted primary-care staff to refer patients with type 2 diabetes to self-management education, boosting referral rates from about 1% to 13% over 18 months. Adding standing orders for nurses sustained the effect, suggesting simple EHR prompts can markedly improve DSMES uptake.
- Journal
- Diabetes care (Q1)
- Published
- 16 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Katrina E Donahue, Jacqueline R Halladay, Ping Chen, Kathleen Mottus, Karen Goeke-Austin, Jennifer Rees, et al.
- PMID
- 42747941
- DOI
- 10.2337/dc26-1213
Why clinicians should know about it
- Picked for Internal Medicine (top studies of the week, 20 September 2026): Cluster RCT of EHR advisory for DSMES referrals
- Picked for Family Practice (top studies of the week, 20 September 2026): Electronic advisory improves DSMES referrals, quality‑improvement
Abstract
OBJECTIVE: Engagement in diabetes self-management education and support (DSMES) is suboptimal among people with type 2 diabetes (T2D). The PROMPT study examined whether referral rates to DSMES increased through a best practice advisory (BPA) deployed during clinic visits via the electronic health record. RESEARCH DESIGN AND METHODS: In this cluster-randomized controlled trial in central North Carolina, we created a BPA within the electronic health record that deployed when eligible patients with T2D attended primary care visits. The BPA was active in four primary care practices over 18 months, with two control practices. After 12 months, standing orders were added so the BPA would additionally deploy for nurses or medical assistants before patients saw their clinician. We analyzed data using multilevel logistic regression modeling with patient data nested within clinics, using binary logit functions and maximum likelihood estimation to estimate the odds of DSMES referrals. RESULTS: At 12 months, the BPA intervention achieved a 12.9% DSMES referral rate compared with 1.2% in control clinics (P < 0.001). At 18 months, the referral rate remained higher in the intervention clinics (13.7%) than in controls (1.6%; P < 0.001). After adjusting for patient and clinic characteristics, the odds of referral in BPA-exposed clinics were significantly greater than in control clinics at both time points: odds ratio (OR) 10.55 (95% CI 4.65-23.94) at 12 months and OR 9.44 (95% CI 4.91-18.17) at 18 months after implementation of standing orders. CONCLUSIONS: Integrating BPA prompts into the electronic health record boosts DSMES referral rates, and adding standing orders helps sustain these gains.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.