Document Detail

Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.
MedLine Citation:
PMID:  23027319     Owner:  NLM     Status:  MEDLINE    
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.
PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases.
Mary Reed; Jie Huang; Ilana Graetz; Richard Brand; John Hsu; Bruce Fireman; Marc Jaffe
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Annals of internal medicine     Volume:  157     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-02     Completed Date:  2012-12-04     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  482-9     Citation Subset:  AIM; IM    
Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA.
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MeSH Terms
Ambulatory Care / standards*
Child, Preschool
Cholesterol, LDL / blood
Diabetes Mellitus / blood,  drug therapy*
Drug Monitoring
Electronic Health Records / standards*
Hemoglobin A, Glycosylated / analysis
Hypoglycemic Agents / administration & dosage,  therapeutic use*
Hypolipidemic Agents / therapeutic use
Middle Aged
Outcome Assessment (Health Care)*
Regression Analysis
Young Adult
Grant Support
Reg. No./Substance:
0/Cholesterol, LDL; 0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents; 0/Hypolipidemic Agents

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