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Comparative Effectiveness Research in DARTNet Primary Care Practices: Point of Care Data Collection on Hypoglycemia and Over-the-Counter and Herbal Use Among Patients Diagnosed With Diabetes

Libby, Anne M. PhD*; Pace, Wilson MD; Bryan, Cathy MHA, BSN, RN; Orton Anderson, Heather PhD*; Ellis, Samuel L. PharmD*; Read Allen, Richard MS§; Brandt, Elias BS; Huebschmann, Amy G. MD; West, David PhD; Valuck, Robert J. PhD, RPh*

doi: 10.1097/MLR.0b013e3181ddc7b0
Comparative Effectiveness

Background: The Distributed Ambulatory Research in Therapeutics Network (DARTNet) is a federated network of electronic health record (EHR) data, designed as a platform for next-generation comparative effectiveness research in real-world settings. DARTNet links information from nonintegrated primary care clinics that use EHRs to deliver ambulatory care to overcome limitations with traditional observational research.

Objective: Test the ability to conduct a remote, electronic point of care study in DARTNet practices by prompting clinic staff to obtain specific information during a patient encounter.

Research Design: Prospective survey of patients identified through queries of clinical data repositories in federated network organizations. On patient visit, survey is triggered and data are relinked to the EHR, de-identified, and copied for evaluation.

Subjects: Adult patients diagnosed with diabetes mellitus that scheduled a clinic visit for any reason in a 2-week period in DARTNet primary care practices.

Measures: Survey on hypoglycemic events (past month) and over-the-counter and herbal supplement use.

Results: DARTNet facilitated point of care data collection triggered by an electronic prompt for additional information at a patient visit. More than one-third of respondents (33% response rate) reported either mild (45%) or severe hypoglycemic events (5%) in the month before the survey; only 3 of those were also coded using the ICD-9 (a significant difference in detection rates 37% vs. 1%). Nearly one-quarter of patients reported taking an OTC/herbal, 4% specifically for the treatment of symptoms of diabetes.

Conclusions: Prospective data collection is feasible in DARTNet and can enable comparative effectiveness and safety research.

From the *University of Colorado School of Pharmacy, Denver, CO; †University of Colorado School of Medicine, Denver, CO; ‡American Academy of Family Physicians, Denver, CO; §Peak Statistical Services, Evergreen, CO; and ¶QED Clinical Inc., dba CINA, Dallas, TX.

Reprints: Anne M. Libby, PhD, 12631 E. 17th Ave., C238-L15, Academic Office 1, University of Colorado School of Pharmacy, Aurora, Colorado. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.