Electronic health records (EHRs) improve both care and overall outcomes for patients with diabetes, especially for those with poor disease control, says an Oct. 2 Annals of Internal Medicine study(annals.org).
According to the study's authors, EHRs helped improve drug treatment intensification, monitoring and physiologic control for most patients with diabetes, and they saw the greatest improvements in patients with poor control.
Researchers took advantage of the results generated by the 2005-2008 implementation of a certified EHR system in 17 medical centers in the Kaiser Permanente Northern California integrated delivery system. Focusing on two clinical measures -- glycemic control as measured by hemoglobin A1c (HbA1c) and low-density lipoprotein cholesterol (LDL-C) -- they were able to determine the effect of EHR use on those measures for nearly 170,000 patients. They also were able to examine differences in the effect of the EHR across different levels of disease control.
"Across all baseline HbA1c and LDL-C levels, the EHR was associated with statistically significantly reduced follow-up values, with greater reductions among patients with higher baseline values," the authors wrote. "Among patients with a baseline HbA1c value of 9 percent or greater, the EHR was associated with a decrease of 0.14 percent … 0.08 percent for patients with baseline HbA1c values of 7 percent to 8.9 percent and 0.05 percent for those with baseline values less than 7 percent."
Patients with poorer control also showed statistically significant improvements in getting follow-up HbA1c and LDL-C tests faster. For patients already meeting recommended glycemic and lipid control targets, EHR use was associated with lower rates of repeated testing within 90 days, which may represent a decrease in potential overtesting.
"Our findings … suggest actual improvements in the clinical care of patients with diabetes," the authors wrote. "These early effects on linked care processes and patient outcomes also suggest the potential for future downstream improvements in major clinical event rates and health. Overall, our study suggests that the EHR may be a powerful tool to help clinicians deliver well-targeted, high-quality care of chronic disease and improve patient outcomes."