Electronic health records fail to boost diabetes care
MedWire News: Primary care practices that use electronic health records (EHRs) as opposed to paper-based methods do not necessarily provide improved quality of care for patients with diabetes, report researchers.
"Recent efforts to encourage meaningful use of EHRs assume that widespread adoption will improve the quality of ambulatory care, especially for complex clinical conditions such as diabetes," write Jesse Crosson (Robert Wood Johnson Medical School, New Jersey, USA) and colleagues in the Annals of Family Medicine.
However, few studies other than those conducted by a small number of leading organizations, have shown an association between EHR use and improved quality of care, say the team.
Crosson et al analyzed diabetes quality-of-care data from practices that participated in the Using Learner Teams for Reflective Adaptation (ULTRA) trial. Sixteen of the practices used EHRs and 26 used paper-based record-keeping systems. All practices had exclusively used either one or other of the systems for at least 1 year before the study began. The team assessed data collected at baseline, and at 1 and 2 years of follow up.
Quality of diabetes care was evaluated by assessing adherence to chronic disease guidelines (issued by the US Preventive Services Task Force and the American Diabetes Association) in three areas of diabetes care: processes of care, treatment, and achievement of intermediate outcomes.
The researchers report that EHR use was not associated with improved adherence to guidelines compared with the use of paper records.
In fact, regression analysis showed that at 2 years of follow up, patients from practices with a paper-based versus EHR record system were significantly more likely to have met outcome targets for glycated hemoglobin, low-density lipoprotein cholesterol, and blood pressure, at an odds ratio of 1.67.
Each data collection showed that over half of patients were receiving recommended processes of care, but the improvements from baseline were not significant, and did not differ significantly between the electronic and paper record groups.
Similarly, adherence to treatment guidelines overall was significantly improved at 2 years of follow up compared with baseline, at 51.7% versus 43.8%, but rates of improvement did not differ between the two groups.
"Our findings show that even after the potentially disruptive phase of initial EHR implementation, quality improvements remain elusive," say Crosson and team.
"Our findings suggest that those who already use EHR technology in primary care will need support in redesigning their work processes and improvements in existing technology to achieve the truly meaningful and successful use of EHRs needed to improve individual patient care and population health outcomes," they conclude.
By Sally Robertson