According to a recent study from the Oakland-based integrated provider, Kaiser Permanente, use of EHRs can lead to improvements in drug-treatment intensification, monitoring, and risk-factor control for patients that have diabetes. The study, which appears in the current issue of Annals of Internal Medicine, found that with patients who have poor control of their diabetes and lipids there were greater improvements as well.
“What we saw in this study is that the EHR really helped our alignment with quality measures and clinical guidelines for treatment,” Marc Jaffe, M.D., clinical leader, Kaiser Permanente Northern California Cardiovascular Risk Reduction Program, said in a statement. “Increases in information availability, decision support and order-entry functionality help clinicians to identify the most appropriate patients for drug-treatment intensification and retesting, which leads to better care of patients with diabetes.”
The were improvements in drug-treatment intensification (increases in medication) for patients with HbA1c values of 7 percent or greater and increases in guideline-recommended follow-up testing for patients who had elevated lab results. HbA1c levels indicate how high a patient’s blood glucose has been on average over an 8- to 12-week period. High levels of low-density lipoproteins (measured by LDL-C levels), or “bad” cholesterol, can lead to a buildup of cholesterol in the arteries. The researchers say the use of an EHR was associated with improved HbA1c and LDL-C levels among all patients.
The researchers used what’s called a quasi-experimental design with outpatient EHR implementation sequentially across 17 medical centers in Kaiser Permanente’s Northern California integrated system. The study included 169,711 patients with diabetes mellitus. Researchers adjusted for patient characteristics, medical center, time trends and facility-level clustering.
With Kaiser’s widespread EHR, researchers were able to examine data and evaluate the EHR effects as well as concurrent controls to adjust for trends in diabetes care practice unrelated to EHR, explained the researchers.
This study follows previous research published in Health Affairs in 2010, which showed that secure messaging improves the effectiveness of care for patients with diabetes and hypertension.