Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
NURS 5051: Transforming Nursing and Healthcare Through Technology Walden University
Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
Diabetes mellitus (DM) is a major public health challenge across the globe that is allied to numerous devastating clinical conditions. Data from the 2020 National Diabetes Statistics Report show that 10.5% of the U.S. population or 34.2 million Americans of all ages had DM in 2020, with projections suggesting that the incidence will be threefold by 2050 (Centers for Disease Control and Prevention, 2020). DM is associated with a significant financial burden and its complexity to the country’s healthcare system are substantial, given that every one in four healthcare dollars is used to meet the care needs of diabetic patients (Sun et al., 2018). Effective DM management necessitates ongoing teamwork between patients and their clinicians; however, the existing healthcare systems’ infrastructure inadequately supports the needs of individuals with chronic diseases (Sun et al., 2018) Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies. Personal health records (PHRs) or patient portals are health information applications that facilitate patient–clinician (s) collaboration in the management of newly diagnosed DM, consequently improving efficiency in healthcare service delivery(Coughlin et al., 2017). The present annotated bibliography reviews articles published in the last five years identified from PubMed and Embase through the Walden University Library to examine how patient portals support patients with newly detected DM.
Annotated Bibliography
Coughlin, S., Heboyan, V., Young, L., De Leo, G., & Wilkins, T. (2018). Use of a web portal by adult patients with pre-diabetes and type 2 diabetes mellitus seen in a family medicine outpatient clinic. Journal of Hospital Management and Health Policy, 176(5), 1–11. https://doi.org/10.21037/jhmhp.2018.04.04.Use
The introductory section of the article highlights the significance of the public health problem. It cites that >30 million Americans had DM by 2015 and at least 35% of adults had impaired fasting glucose or impaired glucose tolerance (prediabetes), which is allied to a 400% higher odds of progressing to full-blown DM than normoglycemic adults (S. S. Coughlin et al., 2017). The article recognizes the importance of effective glycemic control, especially among patients with type 2 DM, which necessitates effective communication and collaboration between providers and patients regarding self-management. Coughlin et al. (2018) conducted a practicability investigation to examine the utility of a web-based portal for adults diagnosed with prediabetes and type 2 DM at a family medicine outpatient clinic.
The authors reviewed electronic medical records (EMR) of the clinic focusing on the number of adult patients with prediabetes and type 2 DM registering in the web-based portal, including their ethnicity, race, gender, and age. The authors of the cross-sectional study employed the STATA software to obtain P values, 95% confidence intervals, and odds ratios, as well as a CHI square test to compute for interactions. A sum of n = 2,376 patients with type 2 DM and n = 866 with prediabetes were observed in the clinic during the study period, with 34.7% and 41.5% registering for the web portal, respectively. Caucasian patients were highly likely to sign up with the patient portal than their African American counterparts, mainly those aged between 25 and 65 years. Race seemingly modified the link between the gender of patients with type 2 DM and web portal registration; however, the effect was statistically insignificant. The findings of the study reveal the low uptake of patient web-based portals among patients diagnosed with prediabetes and type 2 diabetes. The results also highlight the need for additional studies to determine the barriers to the uptake of the web-based portals, which have been evidenced to foster self-management skills Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies.
Nguyen, O. T., Tabriz, A. A., Huo, J., Hanna, K., Shea, C. M., & Turner, K. (2021). Impact of asynchronous electronic communication–based visits on clinical outcomes and health care delivery: Systematic review. Journal of Medical Internet Research, 23(5). https://doi.org/10.2196/27531
The article reviews the literature on how e-visits have influenced patient outcomes and healthcare costs, utilization, access, and quality. The authors searched three online databases, namely: Web of Science, Embase, and MEDLINE, for peer-reviewed articles published from January 2000 to October 2020 focusing specifically on the effects of e-visits o healthcare delivery and clinical outcomes. The electronic search yielded 1859 articles; however, 19 that fulfilled the systematic review’s criteria were selected. The meta-synthesis of findings of individual studies led to the conclusion that e-visit improved clinical outcomes for patients with DM. The described e-visits involved non-simultaneous communication between patients and their clinicians via the patient portal. In addition to decreasing the cost of in-person consultations, the use of patient portals enables patients and the interdisciplinary team involved in DM care to communicate at an opportune time, thereby removing planning impediments. The authors also noted that e-visits enhanced documentation of doctor-patient interaction, which allowed the patients to evaluate the physician’s instructions. In sum, the meta-synthesis provides evidence suggesting that patient portals offer comparable clinical outcomes to in-person diabetic care and decrease costs associated with healthcare delivery.
Osborn, C., Mayberry, L., Mulvaney, S., & Hess, R. (2017). Patient web portals to improve diabetes outcomes: A systematic review. Current Diabetes Reports, 94(3), 36–46. https://doi.org/10.1007/s11892-010-0151-1.Patient
The study is a systematic review that sought to evaluate the efficacy of patient web portals in improving patient outcomes. The authors searched PsycInfo and MEDLINE databases for peer-reviewed articles on the use of patient portals by patients with DM published between January 2010 and June 2020. The search was limited to studies appraising the utility of patient web portals for delivering medical information to diabetic patients irrespective of the study design. The electronic search yielded 133 studies but only 26 met the eligibility criteria. The meta-synthesis of the findings showed that patient web portals substantially improved diabetic outcomes, enhanced disease management, expanded access to health information, elevated overall patient satisfaction with care, and streamlined patient-clinician communication. Based on the synthesis results, the authors recommended the need for designing and enforcing patient web portals that fulfill the needs of both clinicians and patients. The authors highlighted the need for using the portals for health literacy and patient-centeredness.
Graetz, I., Huang, J., Muelly, E. R., Fireman, B., Hsu, J., & Reed, M. E. (2020). Association of mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. JAMA Network Open, 3(2), 1–11. https://doi.org/10.1001/jamanetworkopen.2019.21429
The authors recognize the pertinence of online patient portals in fostering self-management among patients with DM stating that mobile devices broaden access to patient portal services. The study aimed to investigate the effect of mobile patient access on glycemic control and medication compliance among adults diagnosed with DM. The authors adopted a retrospective cohort design to answer the research question, involving a post-hoc analysis of EMR data of 111463 diabetic patients observed at Kaiser Permanente Northern California from April 2015 to December 2017. Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies The results illustrated that gaining mobile portal access substantially elevated medication compliance behaviors, which, in turn, contributed to long-term controlled glycemic levels. The enhancements were significantly larger in patients with elevated blood glucose levels at the start of the study. The above results indicate that expedient access to self-management tools through the web patient portal via cellular devices could substantially enhance diabetes care.
Conclusion
Patient portals or PHRSs are health information applications that facilitate patient-clinician(s) collaboration in the management of newly diagnosed DM. The current assignment was to develop an annotated bibliography of articles examining how patient portals support patients with newly detected DM. Four articles were selected, including two systematic reviews, one using a retrospective cohort design, and another cross-sectional study. The studies provided evidence supporting the need for implementing PPRs. Undeniably, web-based patient portals improve clinical outcomes of patients with DM and they are associated with efficiency in diabetic care delivery Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies.
References
Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Coughlin, S., Heboyan, V., Young, L., De Leo, G., & Wilkins, T. (2018). Use of a web portal by adult patients with pre-diabetes and type 2 diabetes mellitus seen in a family medicine outpatient clinic. Journal of Hospital Management and Health Policy, 176(5), 1–11. https://doi.org/10.21037/jhmhp.2018.04.04.Use
Coughlin, S. S., Williams, L. B., & Hatzigeorgiou, C. (2017). A systematic review of studies of web portals for patients with diabetes mellitus. MHealth, 3, 23–23. https://doi.org/10.21037/MHEALTH.2017.05.05
Graetz, I., Huang, J., Muelly, E. R., Fireman, B., Hsu, J., & Reed, M. E. (2020). Association of mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. JAMA Network Open, 3(2), 1–11. https://doi.org/10.1001/jamanetworkopen.2019.21429 Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
Nguyen, O. T., Tabriz, A. A., Huo, J., Hanna, K., Shea, C. M., & Turner, K. (2021). Impact of asynchronous electronic communication–based visits on clinical outcomes and health care delivery: Systematic review. Journal of Medical Internet Research, 23(5). https://doi.org/10.2196/27531
Osborn, C., Mayberry, L., Mulvaney, S., & Hess, R. (2017). Patient web portals to improve diabetes outcomes: A systematic review. Current Diabetes Reports, 94(3), 36–46. https://doi.org/10.1007/s11892-010-0151-1.Patient
sun, r., korytkowski, m. t., sereika, s. m., saul, m. i., li, d., & burke, l. e. (2018). patient portal use in diabetes management: Literature review. JMIR Diabetes, 3(4). https://doi.org/10.2196/11199 Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies