Teri Carlson, RN

Final Project

2010 MMI 406

This project is focused on the creation of a Gestational Diabetes Clinical Decision Support System.

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.

Mother Fetus

Maternal/Fetal Dyad

Gestational Diabetes

Preeclampsia

C-section

Type 2 DM

biomedme.com/.../01/gestational-diabetes.jpg

Perinatal mortality Macrosomia Birth trauma Hyperbilirubinemia Neonatal Hypoglycemia

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%

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

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 Registry http://ww.delphihealth.com/sol_overview.html

The Registry decision support information is based on the American Diabetes Association best clinical practices for Gestational Diabetes

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

Decision Tree for Pharmacological Treatment of GDM

http://spectrum.diabetesjournals.org/content/20/2/101/F1.expansion.html

Obgyn GDM Dashboard

Patients with Remote Blood Glucose Monitoring

Patients Referred to Perinatologyg

Wireless Diabetic Monitoring

http://www.medgadget.com/archives/2009/07/myglucohealth_adds_sms_email_messaging_capabilities.html

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