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The Effectiveness of Implementing an Electronic Health Record on Diabetes Care and Outcomes
Author(s) -
Herrin Jeph,
Graca Briget,
Nicewander David,
Fullerton Cliff,
Aponte Phil,
Stanek Greg,
Cowling Terianne,
Collinsworth Ashley,
Fleming Neil S.,
Ballard David J.
Publication year - 2012
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2011.01370.x
Subject(s) - medicine , diabetes mellitus , blood pressure , emergency medicine , medical prescription , aspirin , electronic health record , audit , health care , nursing , management , economic growth , economics , endocrinology
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 J anuary 1, 2005 to D ecember 31, 2010. The study sample was limited to patients aged 40 years or older. Study Design A naturalistic experiment in which GE C entricity P hysician O ffice– EMR 2005 was rolled out over a staggered 3‐year schedule. Data Collection Chart audits were conducted using the AMA / P hysician C onsortium A dult D iabetes M easure set. The primary outcome was the H ealth P artners’ “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.