Document Detail

The effect of electronic health records on the use of clinical care guidelines for patients with medically complex conditions.
MedLine Citation:
PMID:  21965486     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The emergence of health information technology provides an opportunity for health care providers to improve the quality and safety of dental care, particularly for patients with medically complex conditions.
METHODS: The authors randomized each of 15 dental clinics (HealthPartners, Bloomington, Minn.) to one of three groups to evaluate the impact of two clinical decision support (CDS) approaches during an 18-month study period. In the first approach--provider activation through electronic dental records (EDRs)--a flashing alert was generated at the dental visit to identify patients with medically complex conditions and to direct the dental care provider to Web-based personalized care guidelines. In the second approach--patient activation through personal health records--a secure e-mail was generated or a letter was mailed to patients before dental visits encouraging them to ask their dental care provider to review the care guidelines specific to their medical conditions.
RESULTS: The authors evaluated the rate of reviewing care guidelines among 102 providers. Participants in the provider and patient activation groups increased their use of the system during the first six months, which had a generalized effect of increasing use of the guidelines for all patients, even if they were not part of the study (P < .05). The study results showed that provider activation was more effective than was patient activation. However, providers did not sustain their high level of use of the system, and by the end of the study, the rate of use had returned to baseline levels despite participants' continued receipt of electronic alerts.
CONCLUSIONS: The study results demonstrated that review of clinical care guidelines for patients with medically complex conditions can be improved with CDS systems that involve the use of electronic health records.
CLINICAL IMPLICATIONS: As the U.S. population ages, dentists must be vigilant in adapting care for patients with medically complex conditions to ensure therapeutic safety and effectiveness. Expanded use of CDS via EDRs can help dental care providers achieve this objective.
James Fricton; D Brad Rindal; William Rush; Thomas Flottemesch; Gabriela Vazquez; Merry Jo Thoele; Emily Durand; Chris Enstad; Nelson Rhodus
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of the American Dental Association (1939)     Volume:  142     ISSN:  1943-4723     ISO Abbreviation:  J Am Dent Assoc     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-03     Completed Date:  2012-02-27     Revised Date:  2012-05-08    
Medline Journal Info:
Nlm Unique ID:  7503060     Medline TA:  J Am Dent Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1133-42     Citation Subset:  D; IM    
HealthPartners Research Foundation, 8170 33rd Ave.South, Bloomington, MN 55440-1524, USA.
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MeSH Terms
Decision Support Systems, Clinical
Dental Care for Chronically Ill*
Dental Informatics
Dentist-Patient Relations
Diabetes Mellitus
Electronic Health Records*
Electronic Mail
Heart Failure / complications
Individualized Medicine
Intervention Studies
Patient Safety
Point-of-Care Systems
Practice Guidelines as Topic*
Prospective Studies
Pulmonary Disease, Chronic Obstructive / complications
Quality of Health Care
Sjogren's Syndrome / complications
Xerostomia / complications
Grant Support
R18 HS017270/HS/AHRQ HHS
Comment In:
J Am Dent Assoc. 2012 Apr;143(4):331-2; author reply 332   [PMID:  22467690 ]
J Am Dent Assoc. 2012 Apr;143(4):332-3; author reply 333-4   [PMID:  22467692 ]

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