Researchers from Case Western Reserve University, Cleveland, report that provider practices using electronic health-record systems had higher rates of compliance with clinical quality improvement measures for diabetic patients than did their clinical counterparts using paper-based record systems.
Study finds higher clinical quality compliance at practices using EHRs
The research work was conducted in the Cleveland area, one of 16 communities the Robert Wood Johnson Foundation selected to receive funding for the foundation's Aligning Forces for Quality program. Through the program, office-based physician practices report on quality-of-care and outcomes measures for patients who have chronic medical conditions. Some of the participating Cleveland practices use paper-based recordkeeping systems; other use EHRs. All were members of the Better Health Greater Cleveland, a RWJR-funded collaborative for practice improvement.
The researchers' report, "Electronic Health Records and Quality of Diabetes Care," was published today in the New England Journal of Medicine.
Data measuring the care for diabetics has been reported six times under the auspices of the Better Health Greater Cleveland program and has come from practices with a high concentration of primary-care physicians.
The data reflect a review of nine quality standards—four process measures and five outcomes standards—for the care of diabetics.
The researchers looked at data from 569 primary-care providers, representing 46 practices and seven healthcare organizations, for 27,207 adult patients with diabetes from July 2009 through June 2010. A sample of group practices was split between 33 EHR-enabled provider groups and 13 paper-based practices.
The data on participating care organizations showed wide disparities in patient mixes. The uninsured-patient percentage the 53 practitioners in the 13 paper-based practices was more than five times higher than that for the 516 practitioners in 33 EHR-equipped practices. Practitioners in paper-based practices also saw higher proportions of Medicaid patients and nearly five times fewer commercially insured patients, a 28-point difference.
Data unadjusted for these disparities show nearly 51% of patients at EHR sites received care that met all four process measures, compared with not quite 7% for patients receiving care at paper-based sites—a 44-percentage-point spread. Unadjusted data for outcomes showed almost 44% of patients at EHR sites met four of the five outcomes targets, compared with not quite 16% of patients in paper-based practices.
"These findings were similar but somewhat blunted in analyses that adjusted for insurance type, age, sex, race or ethnic group, language preference, estimated household income and educational level,” according to the authors, with spreads for the adjusted measures of nearly 35 percentage points for care measures and 30 points for outcomes.
The authors warned against "inferring that EHRs fully account for the observed differences in quality." They also noted their study did not confirm improvement in quality improvement measures "after the conversion from paper to electronic records, which would provide more compelling evidence of the benefits of EHRs." That evidence may come after more area practices convert from paper to EHRs, the authors said.
Still, the authors concluded, "These findings support the premise that federal policies encouraging the meaningful use of EHRs may improve the quality of care across insurance types."
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