Currently submitted to: Journal of Medical Internet Research
Date Submitted: Jul 5, 2019
Open Peer Review Period: Jul 9, 2019 - Sep 3, 2019
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Verification of enhanced glycemic control by PHR in diabetic patients through integration of real-world patient and clinician-generated health data
The effectiveness of personal health record (PHR) in diabetes management has already been verified in several clinical trials. However, limitations in the clinical trial, unconsidered PHR implementation concerns, and inappropriate baseline difference between study groups lead to a lack of generalizability of previous study results.
To analyze the effectiveness of PHR in diabetes management by integrating clinical data generated by patients with those generated in the hospital.
We gathered log data of the sugar function (the blood glucose level menu) in My Chart in My Hand version 2.0 (MCMH 2.0) from Asan Medical Center, Seoul, the Republic of Korea between December 2015 and April 2018. We gathered electronic medical records (EMRs) of MCMH 2.0 users and combined them with PHR data. We classified users according to whether they were continuous users and analyzed their characteristics. We compared the hemoglobin A1c (HbA1c) trend, pattern, and target-regulated patient proportion by continuous use.
The total number of MCMH 2.0 sugar function users was 64,932, with 7,453 users having appropriate PHR record and diabetes criteria. Continuous and non-continuous users were 133 and 7,320, respectively. Compared with non-continuous users, continuous users were younger (P<0.001) and had higher male proportion (P<0.001). Furthermore, continuous users had shorter measurement terms (P<0.001) and shorter first and last measurement duration (P=0.043). Diabetes severity-related factors were not statistically significantly different between continuous and non-continuous users. Continuous users seemed to have a more decrease in HbA1c (P=0.020) and a higher proportion in regulated HbA1c <6.5 % (P=0.010).
Integration and analysis of patient- and clinician-generated data prove the improvement in diabetes management by the continued use of PHR. This suggests a solution for concerns about the effectiveness of PHR in diabetes management and gives certainty in PHR implementation to the real world.
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