Kaiser study links EHRs with improved diabetes care

A Kaiser Permanente study using electronic health records to track diabetes patients at 17 medical centers found that such providers were better able to monitor patients and thus order appropriate treatment changes and follow-up testing. In particular they found that EHR use led to greater improvements for patients with poorer control of their diabetes and lipids.

The study involved 169,711 outpatients tracked between 2004 and 2009 in Kaiser Permanente's Northern California treatment system. An EHR system was installed at the facilities between 2005 and 2010, allowing for before-and-after comparisons, as well as trends in diabetes care unrelated to EHRs, according to announcement.

The research, published in the Annals of Internal Medicine, is called "the first study of a large outpatient diabetes population to assess the effect of a complete and certified EHR system" by an article at theheart.org. In total, patients had 1,372,735 HbA1c glucose-level tests and 1,268,086 LDL-C cholesterol tests.

The EHRs were linked with increases in medication when warranted, and there were no changes among patients whose disease was controlled. All patients were significantly more likely to have a follow-up test within one year, while those with good control were less likely to be re-tested within 90 days. In contrast, patients with elevated HbA1c or LDL-cholesterol levels were more likely to be retested more quickly than prior to EHR adoption.

"What we saw in this study is that the EHR really helped our alignment with quality measures and clinical guidelines for treatment," said Marc Jaffe, MD, clinical leader of the Kaiser Permanente Northern California Cardiovascular Risk Reduction Program. "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."

While EHRs have come under renewed criticism lately for not being the money-saver they've been proclaimed to be, they've also received mixed reviews for their ability to improve patient care. As was pointed out this summer, though, whether they do depends on how they are used.

De-identified patient information pulled from electronic health records for roughly 1.1 million diabetics in 10 states has been compiled into the largest private-sector diabetes registry in the United States. Called Surveillance, Prevention, and Management of Diabetes Mellitus DataLink (SUPREME-DM), it is expected to be used to create more comprehensive prevention and treatment strategies for the disease.

To learn more:
- read the announcement
- here's the abstract
- check out theheart.org article

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