Patient-Centered Diabetes Education as an Integral Part of an Electronic Clinic Note using the SEE-Diabetes Modules

One quarter of Americans aged 65 and older has diabetes, each of whom often has additional needs for diabetes education. Diabetes self-management, education, and support (DSMES), when paired with shared decision making (SDM), can empower patients to make decisions about their care. SDM can improve glycemic control, patient satisfaction, quality of life, medication adherence, and trust in physicians. The use of decision aids with SDM can make clinic visits more efficient and satisfying by focusing the discussion on key issues rather than basic education. There is an existing gap in evidence around DSMES because research to date has focused more on clinical decision making regarding drug choices. 

Support-Engage-Empower-Diabetes (SEE-Diabetes) is an educational decision aid that will enable people with diabetes to work with their provider to choose a DSMES strategy. SEE-Diabetes will present information in the patient portal via a new “Patient Education” section of the post-visit clinical note. The modules will allow patients and providers to jointly select individual self-care behaviors that matter most to the patient, while providing access to education materials for ongoing self-care in diabetes. 

The specific aims of the research are as follows:

• Determine SEE-Diabetes information needs of patients and providers.
• Develop and refine SEE-Diabetes module for the EHR clinic note.
• Evaluate feasibility of SEE-Diabetes.

This research is a user-centered development and feasibility test of SEE-Diabetes. Three patient focus groups and three provider focus groups will iteratively evaluate content validity, readability, and usability of SEE-Diabetes modules. The research team will use the Agency for Healthcare Research and Quality’s (AHRQ's) SHARE Approach to integrate SEE-Diabetes into practice. Onboarding sessions will be available for providers. Patients will be given usual reminders for reviewing SEE-Diabetes modules and to complete self-reported measures at relevant intervals. The primary outcome measures are the SDM-Q-9 (patient version) and the SDM-Q-Doc (provider version), nine-point decision-making questionnaires to assess patient’s involvement in the decision-making process. Observation of clinical encounters via audio recordings will result in feasibility findings to address barriers to implementation. 

Researchers aim to have data showing the impact of their educational decision aid on short-term outcomes of DSMES related to patient involvement and implementation barriers. This research will lead to a plan for evaluation of long-term behavioral (e.g., self-efficacy) and health-related biomedical (e.g., glycemic control) outcomes and an evidence-based pathway for translation to clinical practice.