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

Mary Reed, Jie Huang, Ilana Yonas, Richard Brand, John Hsu, Bruce Fireman, Marc Jaffe

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: 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. Objective: To examine the association between use of a commercially available certified EHR and clinical care processes and disease control in patients with diabetes. Design: 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. Setting: Kaiser Permanente Northern California, an integrated delivery system. Patients: 169 711 patients with diabetes mellitus. Intervention: Use of a commercially available certified EHR. Measurements: Drug treatment intensification and hemoglobin A 1c (HbA 1c ) and low-density lipoprotein cholesterol (LDL-C) testing and values. Results: 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). Limitation: The EHR was implemented in a setting with strong baseline performance on cardiovascular care quality measures. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)482-489
Number of pages8
JournalAnnals of internal medicine
Volume157
Issue number7
DOIs
StatePublished - Oct 2 2012

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Electronic Health Records
Patient Care
Diabetes Mellitus
Outpatients
Hemoglobin A
LDL Cholesterol
Odds Ratio
Integrated Delivery of Health Care
Quality of Health Care
Physiologic Monitoring
Pharmaceutical Preparations
Cluster Analysis
Research Design
Therapeutics
Multivariate Analysis
Guidelines

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus. / Reed, Mary; Huang, Jie; Yonas, Ilana; Brand, Richard; Hsu, John; Fireman, Bruce; Jaffe, Marc.

In: Annals of internal medicine, Vol. 157, No. 7, 02.10.2012, p. 482-489.

Research output: Contribution to journalArticle

Reed, Mary ; Huang, Jie ; Yonas, Ilana ; Brand, Richard ; Hsu, John ; Fireman, Bruce ; Jaffe, Marc. / Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus. In: Annals of internal medicine. 2012 ; Vol. 157, No. 7. pp. 482-489.
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AU - Jaffe, Marc

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