Dataset Information

The effectiveness of implementing an electronic health record on diabetes care and outcomes.

ABSTRACT:

Objective

To assess the impact of electronic health record (EHR) implementation on primary care diabetes care.

Data sources

Charts were abstracted semi-annually for 14,051 diabetes patients seen in 34 primary care practices in a large, fee-for-service network from January 1, 2005 to December 31, 2010. The study sample was limited to patients aged 40 years or older.

Study design

A naturalistic experiment in which GE Centricity Physician Office-EMR 2005 was rolled out over a staggered 3-year schedule.

Data collection

Chart audits were conducted using the AMA/Physician Consortium Adult Diabetes Measure set. The primary outcome was the HealthPartners' "optimal care" measure: HbA1c ? 8 percent; LDL cholesterol < 100 mg/dl; blood pressure < 130/80 mmHg; not smoking; and documented aspirin use in patients ? 40 years of age.

Principal findings

After adjusting for patient age, sex, and insulin use, patients exposed to the EHR were significantly more likely to receive "optimal care" when compared with unexposed patients (p < .001), with an estimated difference of 9.20 percent (95% CI: 6.08, 12.33) in the final year between exposed patients and patients never exposed. Components of the optimal care bundle showing positive improvement after adjustment were systolic blood pressure <80 mmHg, diastolic blood pressure <130 mmHg, aspirin prescription, and smoking cessation. Among patients exposed to EHR, all process and outcome measures except HbA1c and lipid control showed significant improvement.

Conclusion

Implementation of a commercially available EHR in primary care practice may improve diabetes care and clinical outcomes.

SUBMITTER: Herrin J

PROVIDER: S-EPMC3401397 | biostudies-literature | 2012 Aug

REPOSITORIES: biostudies-literature

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Publications

The effectiveness of implementing an electronic health record on diabetes care and outcomes.

Herrin Jeph J da Graca Briget B Nicewander David D Fullerton Cliff C Aponte Phil P Stanek Greg G Cowling Terianne T Collinsworth Ashley A Fleming Neil S NS Ballard David J DJ

Health services research 20120117 4

<h4>Objective</h4>To assess the impact of electronic health record (EHR) implementation on primary care diabetes care.<h4>Data sources</h4>Charts were abstracted semi-annually for 14,051 diabetes patients seen in 34 primary care practices in a large, fee-for-service network from January 1, 2005 to December 31, 2010. The study sample was limited to patients aged 40 years or older.<h4>Study design</h4>A naturalistic experiment in which GE Centricity Physician Office-EMR 2005 was rolled out over a ...[more]

PMID: 22250953

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Project description:BackgroundMultiple policy initiatives encourage more cautious prescribing of opioids in light of their risks. Electronic health record (EHR) redesign can influence prescriber choices, but some redesigns add to workload.ObjectiveTo estimate the effect of an EHR prescribing redesign on both opioid prescribing choices and keystrokes.DesignQuality improvement quasi-experiment, analyzed as interrupted time series.ParticipantsAdult patients of an academic multispecialty practice and a federally qualified health center (FQHC) who received new prescriptions for short-acting opioids, and their providers.InterventionIn the redesign, new prescriptions of short-acting opioids defaulted to the CDC-recommended minimum for opioid-naïve patients, with no alerts or hard stops, such that 9 keystrokes were required for a guideline-concordant prescription and 24 for a non-concordant prescription.Main measuresProportion of guideline-concordant prescriptions, defined as new prescriptions with a 3-day supply or less, calculated per 2-week period. Number of mouse clicks and keystrokes needed to place prescriptions.Key resultsAcross the 2 sites, 22,113 patients received a new short-acting opioid prescription from 821 providers. Before the intervention, both settings showed secular trends toward smaller-quantity prescriptions. At the academic practice, the intervention was associated with an immediate increase in guideline-concordant prescriptions from an average of 12% to 31% of all prescriptions. At the FQHC, about 44% of prescriptions were concordant at the time of the intervention, which was not associated with an additional significant increase. However, total keystrokes needed to place the concordant prescriptions decreased 62.7% from 3552 in the 6 months before the intervention to 1323 in the 6 months afterwards.ConclusionsAutocompleting prescription forms with guideline-recommended values was associated with a large increase in guideline concordance in an organization where baseline concordance was low, but not in an organization where it was already high. The redesign markedly reduced the number of keystrokes needed to place orders, with important implications for EHR-related stress.Trial registrationwww.ClinicalTrials.gov protocol 1710018646.

Dataset Information

The effectiveness of implementing an electronic health record on diabetes care and outcomes.

Objective

Data sources

Study design

Data collection

Principal findings

Conclusion

Publications

The effectiveness of implementing an electronic health record on diabetes care and outcomes.

Similar Datasets

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