Primary care practices can boost clinical preventive services with electronic health records and quality improvement support
Small medical practices that upgrade their electronic
health record (EHR) systems to include modules for
clinical decision support and practice-level quality
improvement substantially boost their delivery of a
number of clinical preventive services (CPS), a new
study finds. Despite strong evidence that providing CPS
reduces morbidity and mortality, provision of CPS has
not increased in adult primary care. The researchers
studied 56 primary care practices in New York City.
Overall, the patient population was 59 percent women,
and 55 percent of the patients were age 45 years or
older. The most common diagnoses were high blood
pressure (hypertension), high blood lipids
(dyslipidemia), and diabetes.
Across all practices, 7 of 10 CPS measures increased
following upgrade of the EHR software. Those
measures that increased significantly were blood-glucose
screening (from 46 to 62 percent), recording of
body-mass index (from 66 to 78 percent), blood-pressure
control (from 50 to 55 percent), aspirin therapy
to reduce heart attack risk (from 46 to 53 percent),
recording smoking status (from 77 to 84 percent), breast
cancer screening (from 28 to 32 percent), and influenza
vaccination (from 20 to 24 percent). Only smoking-cessation
intervention and blood-glucose control
measures showed negligible-to-small decreases (a
decline of less than 1 percentage point in each case).
This study was funded in part by the Agency for
Healthcare Research and Quality (HS17059).
More details are in "Health information systems in
small practices: Improving the delivery of clinical
preventive services," by Sarah C. Shih, M.P.H., Colleen
M. McCullough, B.A., Jason J. Wang, Ph.D., and others
in the December 2011 American Journal of Preventive
Medicine 41(6); pp. 603-609.
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