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Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.

ABSTRACT: Physicians can receive federal payments for meaningful use of complete certified electronic health records (EHRs). Evidence is limited on how EHR use affects clinical care and outcomes.To examine the association between use of a commercially available certified EHR and clinical care processes and disease control in patients with diabetes.Quasi-experimental design with outpatient EHR implementation sequentially across 17 medical centers. Multivariate analyses adjusted for patient characteristics, medical center, time trends, and facility-level clustering.Kaiser Permanente Northern California, an integrated delivery system.169 711 patients with diabetes mellitus.Use of a commercially available certified EHR.Drug treatment intensification and hemoglobin A(1c) (HbA(1c)) and low-density lipoprotein cholesterol (LDL-C) testing and values.Use of an EHR was associated with statistically significant improvements in treatment intensification after HbA(1c) values of 9% or greater (odds ratio, 1.10 [95% CI, 1.05 to 1.15]) or LDL-C values of 2.6 to 3.3 mmol/L (100 to 129 mg/dL) (odds ratio, 1.06 [CI, 1.00 to 1.12]); increases in 1-year retesting for HbA(1c) and LDL-C levels among all patients, with the most dramatic change among patients with the worst disease control (HbA(1c) levels ?9% or LDL-C levels ?3.4 mmol/L [?130 mg/dL]); and decreased 90-day retesting among patients with HbA(1c) levels less than 7% or LDL-C levels less than 2.6 mmol/L (<100 mg/dL). The EHR was also associated with statistically significant reductions in HbA(1c) and LDL-C levels, with the largest reductions among patients with the worst control (0.06-mmol/L [2.19-mg/dL] reduction among patients with baseline LDL-C levels ?3.4 mmol/L [?130 mg/dL]; P < 0.001).The EHR was implemented in a setting with strong baseline performance on cardiovascular care quality measures.Use of a commercially available certified EHR was associated with improved drug treatment intensification, monitoring, and physiologic control among patients with diabetes, with greater improvements among patients with worse control and less testing in patients already meeting guideline-recommended glycemic and lipid targets.National Institute of Diabetes and Digestive and Kidney Diseases.

SUBMITTER: Reed M

PROVIDER: S-EPMC3603566 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.

Reed Mary M Huang Jie J Graetz Ilana I Brand Richard R Hsu John J Fireman Bruce B Jaffe Marc M

Annals of internal medicine 20121001 7

<h4>Background</h4>Physicians can receive federal payments for meaningful use of complete certified electronic health records (EHRs). Evidence is limited on how EHR use affects clinical care and outcomes.<h4>Objective</h4>To examine the association between use of a commercially available certified EHR and clinical care processes and disease control in patients with diabetes.<h4>Design</h4>Quasi-experimental design with outpatient EHR implementation sequentially across 17 medical centers. Multiva ...[more]

PMID: 23027319

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Project description:ObjectiveTo characterize nonpsychiatric prescription patterns of antidepressants according to drug labels and evidence assessments (on-label, evidence-based, and off-label) using structured outpatient electronic health record (EHR) data.MethodsA retrospective analysis was conducted using deidentified EHR data from an outpatient practice at a New York City-based academic medical center. Structured "medication-diagnosis" pairs for antidepressants from 35 325 patients between January 2010 and December 2015 were compared to the latest drug product labels and evidence assessments.ResultsOf 140 929 antidepressant prescriptions prescribed by primary care providers (PCPs) and nonpsychiatry specialists, 69% were characterized as "on-label/evidence-based uses." Depression diagnoses were associated with 67 233 (48%) prescriptions in this study, while pain diagnoses were slightly less common (35%). Manual chart review of "off-label use" prescriptions revealed that on-label/evidence-based diagnoses of depression (39%), anxiety (25%), insomnia (13%), mood disorders (7%), and neuropathic pain (5%) were frequently cited as prescription indication despite lacking ICD-9/10 documentation.ConclusionsThe results indicate that antidepressants may be prescribed for off-label uses, by PCPs and nonpsychiatry specialists, less frequently than believed. This study also points to the fact that there are a number of off-label uses that are efficacious and widely accepted by expert clinical opinion but have not been included in drug compendia. Despite the fact that diagnosis codes in the outpatient setting are notoriously inaccurate, our approach demonstrates that the correct codes are often documented in a patient's recent diagnosis history. Examining both structured and unstructured data will help to further validate findings. Routinely collected clinical data in EHRs can serve as an important resource for future studies in investigating prescribing behaviors in outpatient clinics.

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Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.

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Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.

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