Research Activities, May 2013
Electronic health records improve primary care of diabetes
Health Information Technology
Diabetes care focuses on controlling blood-sugar levels and managing diet and exercise to prevent complications. A new study shows that electronic health records (EHRs) in primary care can improve diabetes care and clinical outcomes. It found that EHRs helped more patients obtain optimal care compared to patients whose primary care providers did not have EHRs.
For 6 years, David Ballard, M.D., Ph.D., of the Baylor Health Care System, and colleagues conducted semi-annual chart reviews on 14,051 adult patients 40 years of age and older with diabetes. All were receiving care from 34 primary care practices that were part of the large, fee-for-service HealthTexas Provider Network of the Baylor Health Care System in Dallas-Fort Worth, Texas.
A bundle of several measures were used as a benchmark. The bundle included controlled blood-glucose levels (HbA1c of less than or equal to 8 percent), an LDL-cholesterol level of less than 100 mg/dl, a blood pressure of less than 130/80 mmHg, documented aspirin use, and no smoking. An EHR was rolled out over a 3-year period allowing data to be collected on patients who were either never exposed to an EHR or were exposed to the EHR after implementation.
A greater percentage of patients met the standards of optimal care in the EHR-exposed group compared to the non-exposed group. The longer patients were exposed to an EHR, the greater rate of optimal care. EHR exposure also significantly improved three elements of the bundle: aspirin use, blood pressure control, and smoking status; HbA1c and lipid levels did not improve. Longer exposure to an EHR also produced significant improvements in individual care process measures except for blood pressure measurement, which remained unchanged over time, and urinalysis assessment, which declined.
In the future, decision-support capabilities in EHRs should be enhanced and expanded to target specific outcomes in diabetes care, suggest the researchers. Their study was supported in part by AHRQ (HS20696).
See "The effectiveness of implementing an electronic health record on diabetes care and outcomes," by Jeph Herrin, Ph.D., Briget da Graca, M.S., David Nicewander, M.S., and others in the August 2012 Health Services Research 47(4), pp. 1522-1540.