Electronic health records improve diabetes care and outcomes
Research Activities, October 2012, No. 386
The implementation of commercially available electronic health records (EHRs) in primary care practices may lead to significant improvements in both process of care and patient outcomes for diabetes, concludes a new study. Researchers obtained data on 6 years of semi-annual chart reviews of 14,051 adult patients 40 years of age and older with diabetes. All patients were receiving care from 34 primary care practices that were part of a large, fee-for-service network. The chart reviews included data on several diabetes process-of-care measures and patient outcome measures. Several optimal care measures were used as benchmarks: an HbA1c (measure of blood-sugar level) of 8 percent or less, an LDL-cholesterol level of <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 never exposed to an EHR and patients who were exposed to the EHR, both before and 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 a patient was exposed to an EHR, the greater the likelihood of optimal care. EHR exposure also significantly improved the individual measures of aspirin use, blood pressure control, and smoking status.
Longer exposure to an EHR also produced significant improvements in individual process measures, except for blood pressure measurement, which remained unchanged over time. However, the results found no evidence that EHR use affected HbA1c control, the most important measure of diabetes care. HbA1c and lipid measurement were process-of-care measures that declined slightly under EHR exposure; urinalysis decreased a little more. 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 the Agency for Healthcare Research and Quality (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.