65-OR: A Novel Electronic Medical Record–Based Diabetes Screening Program in the Emergency Department of an Urban Academic Medical Institution

Abstract

Despite decades of research on strategies to address disparities in diabetes screening, prevention and treatment, disparities particularly by race/ethnicity and socioeconomic status persist. An innovative approach to diabetes screening was therefore piloted in the Emergency Department (ED) at the University of Illinois Hospital in Chicago from February to April 2021. A best practices advisory (BPA) was built into the electronic medical records system that flagged ED patients at risk for diabetes for a provider to add a A1c test to an already planned blood specimen. The criteria were: all patients age >= 45 years, or patients age 18-44 years with a BMI >= 25; and, with no history of diabetes in the chart and no A1c performed in the last 3 years. Of the 8441 ED visits during the pilot timeframe, the BPA was triggered in 2691, and 2118 visits had a A1c resulted. Approximately half of the results (52%, n=1098) were abnormal. Of the abnormal results, 70% were in the prediabetes range (A1c 5.7-6.4%) and 30% in the diabetes range (A1c >= 6.5%; with 62 of the A1c results >=10%) . As A1c results were not immediately available in the ED, study staff successfully contacted 352 patients with an abnormal result by phone; the remaining were sent a letter informing them of their abnormal result. Of the 352, the average age was 52.2 years, 55% were female, 65% Non-Hispanic Black, 20% Hispanic, 15% Non-Hispanic White/Other. Half were on either Medicare or Medicaid, and 4% uninsured. The median income of the patients’ zipcodes fell at the 44th percentile of the U.S. income. During this initial phase, our novel screening in the ED identified a significant number of patients with undiagnosed diabetes, particularly minority and poor patients, indicating this approach could be leveraged to further stymie health disparities. Future research will now test the linkage of these new patients to diabetes education and care within the health care system. Disclosure K.K.Danielson: None. B.Rydzon: None. Y.Eisenberg: None. B.T.Layden: None. J.Lin: Research Support; Gilead Sciences, Inc., Novo Nordisk. Funding Novo Nordisk (G2111)