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Rationale, aims, and objectives Lipid screening is central to cardiovascular risk assessment. We sought to determine whether a simple mailed outreach message and facilitated test ordering increase cholesterol screening among federally qualified community health center patients with no recent cholesterol screening test performed. Methods Using a patient-randomized controlled trial, we examined the effects of delivering a simple mailed outreach intervention promoting cholesterol testing and facilitated test ordering (without requiring an office visit). Participants were adult patients 50 to 75 years old, with no diagnosed cardiovascular disease or diabetes, and no cholesterol test within 5 years who had received care from community health centers in Illinois and Arizona. The intervention took place in 2014 and was powered to detect a 10% increase in screening due to the intervention. Results Participantsˈ (n = 480) mean age was 57.5 years, 51.0% were male, and 43.8% were smokers. There was no significant difference between groups in the primary study outcome—completion of total cholesterol and high-density lipoprotein cholesterol tests or complete lipid panel within 3 months; 32 participants (13.3%) in intervention group versus 26 (10.8%) in control group met the primary outcome, with absolute difference of 2.5 percentage points (95% confidence interval −6.6 to 11.6). Conclusions This outreach intervention promoting cholesterol screening was ineffective. Interventions that attempt to minimize barriers to cholesterol screening on multiple fronts and that are more compelling to patients are needed.

Lipid screening is central to cardiovascular risk assessment. We sought to determine whether a simple mailed outreach message and facilitated test ordering increase cholesterol screening among federally qualified community health center patients with no recent cholesterol screening test performed.Using a patient-randomized controlled trial, we examined the effects of delivering a simple mailed outreach intervention promoting cholesterol testing and facilitated test ordering (without requiring an office visit). Participants were adult patients 50 to 75 years old, with no diagnosed cardiovascular disease or diabetes, and no cholesterol test within 5 years who had received care from community health centers in Illinois and Arizona. The intervention took place in 2014 and was powered to detect a 10% increase in screening due to the intervention.Participants' (n = 480) mean age was 57.5 years, 51.0% were male, and 43.8% were smokers. There was no significant difference between groups in the primary study outcome-completion of total cholesterol and high-density lipoprotein cholesterol tests or complete lipid panel within 3 months; 32 participants (13.3%) in intervention group versus 26 (10.8%) in control group met the primary outcome, with absolute difference of 2.5 percentage points (95% confidence interval -6.6 to 11.6).This outreach intervention promoting cholesterol screening was ineffective. Interventions that attempt to minimize barriers to cholesterol screening on multiple fronts and that are more compelling to patients are needed.

Rationale, aims and objectives Large clinical trials demonstrate that lifestyle modification can prevent or delay the onset of diabetes in those with prediabetes. However, recent National Health and Nutrition Survey data suggest that prediabetes often goes unrecognized, and the majority of prediabetic individuals do not report having received lifestyle advice from physicians. We explored whether electronic health record (EHR) query of glucose measurements can identify prediabetic patients, and we estimated rates of prediabetic lifestyle counselling in a large, urban, primary care practice. Methods Electronic search identified patients with plasma glucose levels of 100 to 199 mg dL−1 between 1 June 2007 and 1 June 2009, excluding those with diabetes or diabetic medications/supplies. From these 5366 patients, 100 randomly selected patients underwent classification into provisional categories based on available EHR data: likely prediabetes, likely diabetes, glucose abnormality in the setting of acute illness, or normal glucose metabolism. In those likely to have prediabetes, we assessed lifestyle modification counselling. Results Fifty-eight per cent (95% CI 48% to 68%) of patients sampled were likely to have prediabetes. Fourteen per cent of those sampled were likely to have diabetes. Thirty-one per cent of prediabetics (95% CI 22% to 42%) had documented lifestyle counselling. Counselled patients had a significantly higher baseline mean body mass index compared to those not counselled (34.1 versus 29.9, P = 0.037). Conclusions EHR query using glucose measurements can identify prediabetic patients and those requiring further glucose metabolism evaluation, including those with undiagnosed diabetes. Future research should investigate EHR-based, population-level interventions to facilitate prediabetes recognition and counselling.

Large clinical trials demonstrate that lifestyle modification can prevent or delay the onset of diabetes in those with prediabetes. However, recent National Health and Nutrition Survey data suggest that prediabetes often goes unrecognized, and the majority of prediabetic individuals do not report having received lifestyle advice from physicians. We explored whether electronic health record (EHR) query of glucose measurements can identify prediabetic patients, and we estimated rates of prediabetic lifestyle counselling in a large, urban, primary care practice.Electronic search identified patients with plasma glucose levels of 100 to 199 mg dL(-1) between 1 June 2007 and 1 June 2009, excluding those with diabetes or diabetic medications/supplies. From these 5366 patients, 100 randomly selected patients underwent classification into provisional categories based on available EHR data: likely prediabetes, likely diabetes, glucose abnormality in the setting of acute illness, or normal glucose metabolism. In those likely to have prediabetes, we assessed lifestyle modification counselling.Fifty-eight per cent (95% CI 48% to 68%) of patients sampled were likely to have prediabetes. Fourteen per cent of those sampled were likely to have diabetes. Thirty-one per cent of prediabetics (95% CI 22% to 42%) had documented lifestyle counselling. Counselled patients had a significantly higher baseline mean body mass index compared to those not counselled (34.1 versus 29.9, P = 0.037).EHR query using glucose measurements can identify prediabetic patients and those requiring further glucose metabolism evaluation, including those with undiagnosed diabetes. Future research should investigate EHR-based, population-level interventions to facilitate prediabetes recognition and counselling.