Diabetes Journal Club Margaux Añel-Tiangco, MD

Study Design  Retrospective cohort of primary care practices of Better Health Greater Cleveland  publicly reported achievement of quality standards: July June 2010  General Medicine, Family Practice, Med-Peds MDs  NP and other primary care providers were included in 2009  Patient population  Adults (18-75 y/o) with DM with at least 2 visits to the same practice

Care Standards / Standards of Care  Yes or no to: 1. A1c checked 2. Urine MAC checked 3. On ACE-I or ARB 4. Ophtho exam done 5. Pneumovax administered

Intermediate-outcome Standards  Achievement of at least 4 out of 5: 1. A1c < 8% 2. BP < 140/80 3. LDL < 100 mg/dL 4. On a statin 5. BMI < 30 Non-smoking status

Data collection  EHR (electronic health record) – based orgs provided data on all eligible patients  Paper-based orgs – chart abstractors gathered data from a random sample of patients

Definition of Terms  EHR – Electronic Health Records  Safety-net practice  For medically underserved, uninsured, underinsured  Primarily on Medicare, Medicaid

Patient Characteristics All were Safety Net Practices

Achievement of Care Standards Adjusted for: insurance type, age, sex, race, language, estimated household income, educational level

Achievement of Outcome Standards

EHR vs. Paper-based practices in achievement of Care and Outcome Standards

Conclusion  EHR improves standards of care and outcomes in patients with diabetes, although the effects are attenuated with safety-net patients

Discussion  Previous reports show no effect from EHR in standards of care or outcome  What’s different about this study? 1. Use of EHR-catalyzed care coordination and teamwork 2. Continuity of care was presumed with at least 2 vists/year; compared with previous studies that may have included pt’s with just 1 visit (not necessarily established pts)

Limitations  Selection bias – only limited to practices that publicly reported achievement of quality standards  Is it applicable to other PCPs or other regions?  Ideal to look at improvement in care or outcome standards when transitioning from paper to EHR records  Details on the specific EHR used were not given in the article

Practical applications  Transitioning to EHR may be cumbersome but long-term results appear promising and possible improvement in the quality of care is encouraging

Questions or comments?