{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:03:47Z","timestamp":1789578227733,"version":"build-2803163510"},"reference-count":0,"publisher":"American Diabetes Association","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["1-R34-DK132571-01"],"award-info":[{"award-number":["1-R34-DK132571-01"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Engagement in diabetes self-management education and support (DSMES) is suboptimal among people with type 2 diabetes (T2D). The PROMPT study examined whether referral rates to DSMES increased through a best practice advisory (BPA) deployed during clinic visits via the electronic health record.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>In this cluster-randomized controlled trial in central North Carolina, we created a BPA within the electronic health record that deployed when eligible patients with T2D attended primary care visits. The BPA was active in four primary care practices over 18 months, with two control practices. After 12 months, standing orders were added so the BPA would additionally deploy for nurses or medical assistants before patients saw their clinician. We analyzed data using multilevel logistic regression modeling with patient data nested within clinics, using binary logit functions and maximum likelihood estimation to estimate the odds of DSMES referrals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>At 12 months, the BPA intervention achieved a 12.9% DSMES referral rate compared with 1.2% in control clinics (P &amp;lt; 0.001). At 18 months, the referral rate remained higher in the intervention clinics (13.7%) than in controls (1.6%; P &amp;lt; 0.001). After adjusting for patient and clinic characteristics, the odds of referral in BPA-exposed clinics were significantly greater than in control clinics at both time points: odds ratio (OR) 10.55 (95% CI 4.65\u201323.94) at 12 months and OR 9.44 (95% CI 4.91\u201318.17) at 18 months after implementation of standing orders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Integrating BPA prompts into the electronic health record boosts DSMES referral rates, and adding standing orders helps sustain these gains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-1213","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:26:38Z","timestamp":1789575998000},"update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["From Alert to Action: Electronic Practice Advisory Improves DSMES Referrals Over 18 Months"],"prefix":"10.2337","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4075-2875","authenticated-orcid":false,"given":"Katrina E.","family":"Donahue","sequence":"first","affiliation":[{"name":"1Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC"},{"name":"2Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline R.","family":"Halladay","sequence":"additional","affiliation":[{"name":"1Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC"},{"name":"2Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Chen","sequence":"additional","affiliation":[{"name":"3Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Mottus","sequence":"additional","affiliation":[{"name":"2Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC"},{"name":"4North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Goeke-Austin","sequence":"additional","affiliation":[{"name":"5UNC Health, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Rees","sequence":"additional","affiliation":[{"name":"4North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maihan B.","family":"Vu","sequence":"additional","affiliation":[{"name":"6Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC"},{"name":"7Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Thomas","sequence":"additional","affiliation":[{"name":"5UNC Health, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelli","family":"Hammond","sequence":"additional","affiliation":[{"name":"1Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Merritt","sequence":"additional","affiliation":[{"name":"5UNC Health, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Young","sequence":"additional","affiliation":[{"name":"2Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC"},{"name":"8Division of Endocrinology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,9,16]]},"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/doi\/10.2337\/dc26-1213\/895753\/dc261213.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/doi\/10.2337\/dc26-1213\/895753\/dc261213.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:26:38Z","timestamp":1789575998000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/doi\/10.2337\/dc26-1213\/172544\/From-Alert-to-Action-Electronic-Practice-Advisory"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":0,"URL":"https:\/\/doi.org\/10.2337\/dc26-1213","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"dc261213"}}