Putting a Diabetes Risk Prediction Tool into Practice to Support Shared Clinical Decision Making

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

	This PCORI-funded implementation project is working to make information about patients’ risk for diabetes part of patients’ shared decision making discussions with their clinicians.
More than 84 million Americans are at risk for developing diabetes. Understanding this risk can help patients and clinicians work together to decide on a prevention approach.

What is the goal of this implementation project?

Medicine and lifestyle changes, such as healthy eating and exercise, can help prevent diabetes. But these approaches work better for some people than others. A PCORI-funded study found that people at high risk for diabetes benefited most from taking medicine and making lifestyle changes. People at low risk saw little or no benefit from these approaches. Based on the study’s findings, a PCORI-funded implementation project developed a way to predict a person’s risk of developing diabetes based on data from their health record.

This project is making the risk information part of shared decision making, or SDM, discussions to help patients who are at risk for diabetes and their clinicians to decide on preventive care.

What will this project do?

The project team is working with 39 primary care clinics in two health systems. The team is adding a risk prediction tool to an existing SDM approach. Then they are working to make the SDM approach part of regular care.

In the SDM approach, staff such as pharmacists and nurses who work in the clinics meet with patients at risk for diabetes. They discuss the patient’s risk for diabetes based on the prediction tool. They share information about how lifestyle changes and a medicine called metformin can help prevent diabetes. The staff member helps the patient choose a prevention approach that works for them. The staff member also follows up with the patient’s primary care clinician to let them know about the patient’s choice.

To put the risk prediction tool in place, the project team is:

• Building the tool into the health systems’ patient records systems so that it can identify patients at risk for diabetes
• Training nurses, pharmacists, care coordinators, and primary care providers to use the tool and talk about diabetes risk in SDM sessions
• Including nurse and physician champions at each primary care clinic to promote the use of the tool
• Giving clinicians feedback about patients’ health outcomes

The project team is also a creating a guide to help other health systems use the tool in the future.

What is the expected impact of this project?

This project will demonstrate what is required to make the risk prediction tool part of SDM in standard primary care. Through the project, more than 4,700 patients will have access to personalized information about their risk for diabetes when working with their clinician to come up with a plan to prevent diabetes.

The project evaluation will confirm that patients and clinicians can use the risk prediction tool and the SDM approach as intended. It will also track patients’ health outcomes.

More about this implementation project: