2. This project is
focused on the
creation of a
Gestational
Diabetes Clinical
Decision Support
System.
3. What is Gestational Diabetes ?
The American Diabetes Association defines
Gestational diabetes mellitus (GDM) as any degree of
glucose intolerance with onset or first recognition
during pregnancy.
It generally occurs between the
24-28 week of pregnancy.
It is reported that up to 7% of all
pregnancies are complicated by
GDM.
5. Cost of GDM to the Nation
In 2007 it cost of GDM was $636 million for the 180,000
pregnancies where gestational diabetes was diagnosed.
Maternal $596 million
Neonatal $40 million
Total $636 million
The Cost of Gestational Diabetes to the United States in 2007
Medicaid
• $230
million
• 36%
Insurance
• $355
million
• 56%
Self-pay
• $51
million
• 8%
6. The Keys to Successful Management of GDM
preventing extra healthcare costs
and
negative outcomes for the mother / infant
“Early Identification”
All women will be screened for risk and possible
pre-existing diabetes that they were unaware of
Patient education
Monitoring and if
necessary pharmacological
treatment
The Ob-gyn Practice will use a
diabetic dashboard as a tool.
The clinicians can use to screen,
identify and monitor all the
pregnant women who come to
their practice
Using nationally established
GDM best practice
recommendations
7. Care provided by Ob-gyn Practice
Best
Clinical
Practice
Disease
Management
Patient
Education
Remote
Monitoring
Prepared
Proactive
Providers
Informed
Motivated
Patients
Quality Care…..Lower Costs…..Better Outcomes
Components
Outcomes
Management
Participants
GDM Registryhttp://ww.delphihealth.com/sol_overview.html
The Registry decision support information is based on the American Diabetes
Association best clinical practices for Gestational Diabetes
8. GDM Dashboard
Decision Tree
All moms undergo a GDM
screening at the first visit in the
first trimester
Not at
Risk
At Risk
Second screening
occurs in the 2nd at
trimester 24-26wks
Not Treat for
GDM
Treat for
GDM
Wireless Home Monitoring - BG reading is done at home - The results are sent wireless to the Ob-gyn
practice Dashboard - Built in alerts will show when the mother is not in the desired BG range - The real
time data - leads to real time interventions - versus waiting for the next office visit.
The cost benefit of this is a value add, because early treatment equals less long run complications to
both mother and infant.
Third
Screening at
32-34 weeks
Not Treat
for GDM
Treat for
GDM
9. Decision Tree for Pharmacological
Treatment of GDM
http://spectrum.diabetesjournals.org/content/20/2/101/F1.expansion.html
10. Pts screened for GDM
1st
2nd
3rd
Obgyn GDM Dashboard
Patients with Remote Blood
Glucose Monitoring
Pt Education
Diet
Exercise
Eye exam
Med mgt
Patients Referred to
Perinatologyg
12. Significance of the Technology in Disease Management
Technology Provides
A new way of healthcare delivery, one that
decreases healthcare costs
An avenue to find the best practice interventions
and solutions
A real time monitoring and treatment of
GDM resulting in a decrease of the
associated diabetic co-morbidities
Editor's Notes
Gestational Diabetes Clinical Decision Support System Abstract
This project is focused on the creation of a Gestational Diabetes Clinical Decision Support System.
Gestational Diabetes is a condition that occurs during pregnancy in some women.
The hormones produced by the placenta impact the insulin to regulate the blood glucose creating impaired glucose intolerance in the mother.
The excess maternal glucose is passed on to the Fetus.
Gestational Diabetes has many potential complications for both the mother and the fetus therefore
it can be viewed fro the perspective the mother-child dyad a Two - Patient model.
This Clinical Decision Support System is focused on early identification an Best Practices, establishing early treatment intervention,
possible medication based on a decision tree process.
Real Time monitoring, continues to provide data via a wireless monitoring device.
Medical Data from the initial screening, 2nd and 3rd trimester office screenings, plus any remote wireless data will be used in a Gestational Diabetic Dashboard. The Gestational Diabetic Dashboard at the doctor’s office will allow for screening risk, monitoring the mothers and possible home monitoring real time interventions.
Screening, monitoring and the use of real time interventions related to wireless monitoring, will decrease possible maternal/fetal complications and maintain pregnancy outcome costs.
The Department of Health and Human Services Agency for Healthcare Research and Quality ( AHRQ) in Aug. 5, 2009 released
"Gestational Diabetes: A Guide for Pregnant Women" which reported
"About 7 out of 100 pregnant women get gestational diabetes”.
“Gestational diabetes is more likely for:
Women who are overweight.
Women with family members who have had gestational diabetes.
Women with family members who have type 2 diabetes.
African American, American Indian, and Hispanic/Latina American women"
AHRQ Publication Number: 09-EHC014-A
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=162
Gestational Diabetes has many potential complications for both the mother and the fetus therefore it can be viewed fro the perspective the mother-child dyad a Two - Patient model. The hormones produced by the placenta impact the insulin to regulate the blood glucose creating impaired glucose intolerance in the mother. The excess maternal glucose is passed on to the Fetus. If GDM is not detected early the impact of the excessive maternal glucose can have a very serious impact on the developing fetus leading to birth defects and possible fetal demise.
In 2007 it cost of GDM was $636 million for the 180,000 pregnancies where gestational diabetes was diagnosed in the United States, $596 million for the maternal care and, $40 million for neonatal care. In 2007 Medicaid paid $230 billion for 37% of GDM care in the nation, private insurance companies paid 56% of the cost at $355 million and the remaining 8% was self pay at $51 million.
The ob-gyn practice will use a diabetic registry and dashboard as a tool that the clinicians can use to screen, identify and monitor all the pregnant women who come to their practice by nationally established GDM best practice recommendations. The Key in to successful management of GDM is early identification, patient education, monitoring and if necessary pharmacological treatment. This can prevent extra healthcare costs and potentially negative out comes for both the mother and her infant.
Ortiz, David. "Using a Simple Patient Registry to Improve Your Chronic Disease Care" Family Practice Management Journal, Vol. 13 No 4 (Apr)2006
1) Ortiz, David. "Using a Simple Patient Registry to Improve Your Chronic Disease Care" Family Practice Management Journal, Vol. 13 No 4 (Apr)2006
The registry and dashboard decision software will be based on the American Diabetes Association best clinical practices for Gestational Diabetes.
This flow chart shows the components, management, participants and outcomes of the GDM registry. This Diabetic registry clinical support software is designed for quality assessment and improvement in diabetes care. http://ww.delphihealth.com/sol_ddm_overview.html
At the first prenatal visit all women will be screened for risk
Women who are at Risk for GDM would have: preexisting obesity (BMI greater than or equal to 30), history of GDM, and previous infant malformations, come from a high risk ethnic group, previously had an infant with Macrosomia, a family history of diabetes, the mother’s maternal age is equal to or greater than 35, a history of multiple fetal loss, repetitive glucosuria or the use of a medication that is causing
Hyperglycemia.
GDM usually occurs in the second trimester, at 24-28 weeks there will be a second screening of blood glucose levels.
If it is less than 140 then they will receive routine prenatal care, with a repeat testing in their 3rd trimester (32-34 weeks).
But if their blood glucose is greater than 180, they will take a oral glucose tolerance test if the result is greater than 95mg/dl
they will be referred for an eye exam, GDM Diet and Exercise Education. They will also be given a one hour postprandial test
If those results are greater than 130-140 mg/dl, they will require wireless home monitoring, perhaps medication and a referral to a perinatologist to monitor the fetus's growth and development .
A third Screening will occur at 32-34 weeks; for those who had already begun treatment for GDM, hopefully due to early interventions, diet, exercise, medication and home monitoring the mother will continue to be stable. Others where at risk and Identified as having GDM
Basic Guidelines for Diabetes Care. "Developed by the Diabetes Coalition of California an the California Diabetes Program, revised July 2007."
www.Caldiabetes.org
Here is a decision tree for pharmacological treatment of GDM that came from Diabetes Spectrum April 2007, they stated,
"The use of oral anti-diabetic drugs in pregnancy is an accepted treatment modality for women with gestational diabetes mellitus (GDM). This efficacious option provides physicians more choices that, in turn, translate into more complex decision making for the management of GDM. However, regardless of the mode of therapy, whole patient care (glucose monitoring, education, diet adherence, and so forth) will determine overall success in managing this disease and the potential to maximize the quality of perinatal outcome"
A GDM Dashboard can provide a management platform for real time monitoring and treatment of diabetes resulting in a decrease of the associated diabetic co-morbidities and additional Healthcare costs. Yes, GDM information is entered individually into each patient’s EMR. However, the GDM Dashboard provides a overview of the status of all the practice’s patients in relation to their GDM care and outcomes.
Data continues to be provided via a wireless monitoring device. This Data will be sent into the Gestational Diabetic Dashboard. Allowing for real time interventions from the Obgyn practice. Blood Glucose readings done at home by the patient are sent wirelessly to the Ob-gyn practice Dashboard. The built in “alerts” show when the mother is not in the desired BG range , real time data enables real time interventions versus waiting until next office visit. The cost benefit of this is a value add, because early treatment equals less long run complications to both mother and infant.
Changed HealthPAL to Guardian Real-Time Continuous Glucose Monitoring System (CGMS) http://www.medtronic.com/your-health/diabetes/device/insulin-pumps/guardian-real-time-system/index.htm,
The use of medical informatics technology provides a new way of healthcare delivery, one that decreases healthcare costs.
It is an avenue to find the best practice interventions and solutions. The real time monitoring and treatment of GDM
Which can result in a decrease of the associated GDM problems for both the mother and the fetus.
