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EHRs linked to higher standards of diabetes care
Cebul RD. N Engl J Med. 2011;365:825-833.
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Compared with medical centers that use paper-based systems, those that implemented electronic health records boast better achievements in standards for diabetes care and outcomes, according to recent data.
Researchers from Better Health Greater Cleveland analyzed data collected from 2009 to 2010 on 27,207 adults with diabetes cared for at 569 primary care providers in 46 practices of seven diverse health care systems.
Various health care organizations included in the analysis provide services to vulnerable populations (safety-net organizations). Twelve practices in one safety-net organization and one safety-net practice in a nonsafety-net organization employed electronic health records (EHRs), although all other safety-net organizations used paper-based systems and all nonsafety-net organizations used EHRs. The researchers said 37.8% of all patients in the study received care in safety-net practices.
Care standards included in the evaluation were receipt of a glycated hemoglobin value; testing for urinary microalbumin or prescription of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker; an eye examination; and pneumococcal vaccination. Intermediate-outcome standards included: a glycated hemoglobin value lower than 8%; blood pressure lower than 140/80 mm Hg, LDL cholesterol lower than 100 mg/dL or prescription of a statin; BMI less than 30; and nonsmoking status.
Unadjusted analyses indicated that all four standards of diabetes care were met for 50.9% of patients at EHR sites vs. 6.6% of patients at paper-based sites. EHR sites also had higher achievement of all components or composite standards of care. Results also revealed that outcomes of 43.7% of patients at EHR sites vs. 15.7% of those at paper-based sites met at least four of the five standards. Patients at EHR sites demonstrated higher achievement of all outcome standards, except for one.
Similarly, adjusted analyses showed that diabetes care was 35.1 percentage points higher for EHR sites vs. paper-based sites across all practices. Diabetes outcomes were also significantly better, with data demonstrating a 15.2-percentage-point difference between EHR and paper-based sites. These trends persisted among safety-net and nonsafety-net health care organizations. – by Casey Murphy
Disclosure: The researchers report no relevant financial disclosures.
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