Employing the Electronic Health Record to Improve Diabetes Care: A Multifaceted Intervention in an Integrated Delivery System (original) (raw)
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Purpose: Diabetes affects 25.6 million adults in the United States. This longitudinal secondary data analysis aimed to determine whether the use of electronic health records (EHRs) produces changes in quality of care (process and intermediate outcomes) for the same adult patients diagnosed with type 2 diabetes over time. Methods: This study used data from a CDR and EpicCare system that were queried from pre-EHR, one year post-EHR, and two years post-EHR. The sample included patients aged 18-75 years diagnosed with type 2 diabetes who had outpatient visits at the three time points. Quality of diabetes care was assessed using a guideline developed by the National Diabetes Quality Improvement Alliance in 2005. Process measures included frequency of HbA1c, BP, and lipid profile tests documented for each patient and proportion of patients who had at least one process measure documented at each time point. In addition, intermediate outcome measures included levels of HbA1c, BP, and lipid profile achieved by each patient and proportion of patients who achieved the recommended levels of HbA1c, BP, and lipid profile at each time point. Results: Quality of diabetes care for the 1,201 patients differed pre-and post-EHR. In process measure, the frequency of BP control and the proportion of patients who had at least one BP measurement documented increased one year and two years post-EHR. In intermediate outcome measures, the proportion of patients who achieved total cholesterol <170 mg/dL improved two years post-EHR. However, patients were less likely to achieve HbA1c <7% and SBP <140 mmHg post-EHR. Moreover, levels of HbA1c, BP, and HDL-C of the same patients increased over time. Age, sex, race, and type of health insurance predicted the changes in HbA1c, BP, and HDL-C post-EHR. Conclusion: EHR use improves the BP documentation and promotes changes in clinical staff and patient behavior due to better data at the point of care. Further studies to examine the effect of other comprehensive EHR components (e.g., clinical decision support system) on quality of diabetes care are recommended. Suggestions for hospital administrators to consider EHR adoption and to add nursing care elements to their EHRs are also offered by this study.
Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care
The Annals of Family Medicine, 2012
PURPOSE Recent efforts to encourage meaningful use of electronic health records (EHRs) assume that widespread adoption will improve the quality of ambulatory care, especially for complex clinical conditions such as diabetes. Cross-sectional studies of typical uses of commercially available ambulatory EHRs provide confl icting evidence for an association between EHR use and improved care, and effects of longer-term EHR use in community-based primary care settings on the quality of care are not well understood.
Monitoring change in diabetes care using diabetes registers
Australian family physician, 2006
Tight blood sugar and blood pressure (BP) control is possible in type 2 diabetes and reduces both macrovascular and microvascular complications. 1,2 It can be achieved by structured systematic care of patients in general practice. 3 This needs to be underpinned by information systems that assist with recall and audit, along with provider education, multidisciplinary team work, and shared care with specialist services. 4 Since their inception in 1992, many divisions of general practice 5 have set out to support systematic care for people with diabetes by disseminating evidence based guidelines, educating general practitioners and consumers, providing allied health and shared care with secondary services, as well as establishing local registers for recall and audit. 6 Yet many patients with diabetes do not receive optimal care. Measures of optimal care have been outlined by The Royal Australian College of General Practitioners and Diabetes Australia in the Diabetes management in general practice guidelines for 2000, 7 and intermediate health outcome indicators identified in the diabetes metadata set. 8 We aimed to look for evidence that divisionally orchestrated registers were associated with improvements in quality. Methods This study was part of the National Divisions Diabetes Program (NDDP) Divisions Diabetes and Cardiovascular Quality Improvement Project (DDCQIP). 9 We examined a cohort of general practice patients over 3 years. Division participation Between July to October 2002, 38 divisions of general practice were identified that used the electronic diabetes patient register CARDIAB, of which 23 had continuous data for at least 3 years. Of these, 19 agreed to participate. Data were excluded from three because the registers were not adequate (eg. included many nonactive patients), leaving 16 divisions in the final data analysis. Data were extracted for 3
Informatics in primary care, 2009
To determine the impact of a physician-directed, multifaceted health information technology (HIT) system on diabetes outcomes. A pre/post-interventional study. The setting was Providence Primary Care Research Network in Oregon, with approximately 71 physicians caring for 117 369 patients in 13 clinic locations. The study covered Network patients with diabetes age 18 years and older. The study intervention included implementation of the CareManager HIT system which augments an electronic medical record (EMR) by automating physician driven quality improvement interventions, including point-of-care decision support and care reminders, diabetes registry with care prompts, performance feedback with benchmarking and access to published evidence and patient educational materials. The primary clinical measures included the change in mean value for low density lipoprotein (LDL) target <100 mg/dL or 2.6 mmol/l, blood pressure (BP) target <130/80 mmHg and glycated haemoglobin (HbA1c) tar...
PloS one, 2018
Assess the relationship between timely treatment intensification and hemoglobin A1C (HbA1C) control quality-of-care performance measures, i.e., HbA1C levels, among patients with uncontrolled type 2 diabetes. Electronic medical records and diabetes registry data from a large, accountable care organization (ACO) were used to isolate a sample of adult patients with type 2 diabetes who received at least one oral antidiabetes agent and had at least one HbA1C level measurement ≥8.0% (64 mmol/mol; i.e., uncontrolled diabetes) between 7/1/2011 and 6/30/2015. Treatment intensification status was evaluated for each patient during a 120-day treatment intensification window following the index HbA1c measure. Two-level hierarchical generalized linear models, with patients aggregated at the physician level, were used to assess the association between treatment intensification and achieving HbA1C quality performance measures. 547 patients met study selection criteria and 480 patients had at least ...
Preventing chronic disease, 2008
To provide direction and to support improvements in diabetes care, states must be able to measure the effectiveness of interventions and gain feedback on progress. We wanted to know if data from multiple health clinics that are implementing quality improvement strategies could be combined to provide useful measurements of diabetes care processes and control of intermediate outcomes. We combined and analyzed electronic patient health data from clinic sites across Washington State that used the Chronic Disease Electronic Management System (CDEMS) registry. The data were used to determine whether national and state objectives for diabetes care were met. We calculated the percentage of patients that met standards of care in 2004. The pooled dataset included 17,349 adult patients with diabetes from 90 clinics. More than half of patients were above recommended target levels for hemoglobin A1c testing, foot examination, hemoglobin A1c control, and low-density lipoprotein cholesterol contro...
The Journal of …, 2009
CONTEXT: Diabetes care is challenging in rural areas. Research has shown that the utilization of electronic patient registries improves care; however, improvements generally have been described in combination with other ongoing interventions. The level of basic registry utilization sufficient for positive change is unknown.PURPOSE: The goal of the current study was to examine differential effects of basic registry utilization on diabetes care processes and clinical outcomes according to level of registry use in a rural setting.METHODS: Patients with diabetes (N = 661) from 6 Federally Qualified Health Centers in rural West Virginia were entered into an electronic patient registry. Data from pre- and post-registry were compared among 3 treatment and control groups that had different levels of registry utilization: low, medium, or high (for example, variations in the use of registry-generated progress notes examined at the point-of-care and in the accuracy of registry-generated summary reports to track patients' care). Data included care processes (annual exams, screens to promote wellness, education, and self-management goal-setting) and clinical outcomes (HbA1c, LDL, HDL, cholesterol, triglycerides, blood pressure).FINDINGS: The registry assisted in significantly improving 12 of 13 care processes and 3 of 6 clinical outcomes (HbA1c, LDL, cholesterol) for patients exposed to at least medium levels of registry utilization, but not for the controls. For example, the percent of patients who had received an annual eye exam at follow-up was 11%, 34%, and 38% for the low, medium, and high utilization groups, respectively; only the latter groups improved.CONCLUSIONS: As an initial step to achieving control of diabetes, basic registry utilization may be sufficient to drive improvements in provider-patient care processes and in patient outcomes in rural clinics with few resources.