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- Strength of evidence
- Future studies may show more or less potential of ITDM to improve care
- Our methodology selected a study that showed a negative effect of CDSS on blood pressure
- Only one study showing the effect of foot screening on amputation was identified
- Severity stratification
- Severity stratification and predictive modeling, techniques often used to increase the efficiency of disease management, were not included in the analysis
- Scope of benefits
- ADA estimate approximately 2/3 of diabetic costs due to utilization that was not modeled (general medical utilization and indirect economic costs)
- Cross-applicability of studies
- Diabetes-management programs vary widely in salient features (population under study, programmatic components)
Lack of Data Points (e.g. We were able to identify only one randomized controlled trial demonstrating the salutary effect of foot screening on amputation rates).
Strength of Evidence—regarding the effect of CDSS-based diabetes management on SBP showed a detrimental effect, our model projects worsening blood-pressure control with CDSSs. However, CDSSs in other settings show a neutral effect or improvement in blood-pressure control. Sensitivity analysis showed additional benefits, assuming a neutral effect on blood pressure; thus the model's results may underestimate the true value of CDSSs.
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