Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care

Article Figures & Data

Table 1

Components of Guideline Adherence Scores

Processes of Care Score^a	Treatment Score^b	Outcomes Score^c
HbA_1c assessed within last 6 months	HbA_1c ≤8%, or >8% and on hypoglycemic agent	HbA_1c <7%
Urine microalbumin assessed within last 12 months	–	–
Smoking status assessed within last 6 months	–	–
LDL-C assessed within last 12 months	LDL-C ≤100 mg/dL, or >100 mg/dL and on lipid-lowering agent	LDL-C ≤100 mg/dL
BP recorded at each of 3 previous visits	BP ≤130/85 mm Hg (systolic and diastolic), or >130/85 mm Hg (systolic or diastolic) and on antihypertensive	BP ≤130/85 mm Hg (systolic and diastolic)

BP=blood pressure; HbA_1c = glycated hemoglobin, percentage of total hemoglobin; LDL-C = low-density lipoprotein cholesterol.
↵a Any 3 of 5 required.
↵b All required.
↵c Evaluated both as 2 of 3 required and as all required. The most recent recorded value was used.

Table 2

Patient and Practice Characteristics

Table 3

Percentages of Patients Whose Care Met Quality Standards During the 3-Year Observation Period

	EHR Practices (n=16)		Non-EHR Practices (n=26)		EHR vs Non-EHR Practices	All Practices (N=42)

Quality Measure and Time Point	% of Patients, Mean (SD)	F_2,45 (P Value)	% of Patients, Mean (SD)	F_2,75 (P Value)	F_1,2222 (P Value)	% of Patients, Mean (SD)	F_2,123 (P Value)
Processes of care (3 of 5 criteria met)
Baseline	45.1 (16.8)	0.44 (.65)	55.5 (24.9)	0.40 (.67)	0.02 (.98)	51.5 (22.5)	0.86 (.43)
1-Year follow-up	45.0 (27.7)		57.2 (22.3)			52.5 (24.9)
2-Year follow-up	51.1 (19.8)		60.7 (20.9)			57.0 (20.8)
Treatment (all criteria met)
Baseline	38.2 (14.3)	2.81 (.07)	47.2 (24.9)	1.28 (.28)	0.59 (.55)	43.8 (16.5)	3.26 (.04)
1-Year follow-up	42.2 (18.4)		47.3 (20.1)			45.4 (19.4)
2-Year follow-up	48.6 (13.5)		53.5 (19.8)			51.7 (17.6)
Outcomes (2 of 3 targets met)
Baseline	44.8 (15.3)	0.71 (.50)	52.5 (15.0)	4.32 (.02)	0.30 (.74)	49.6 (15.4)	4.68 (.01)
1-Year follow-up	44.8 (15.3)		52.8 (16.3)			49.8 (16.2)
2-Year follow-up	49.9 (16.0)		61.9 (15.2)			57.4 (16.4)
Outcomes (all targets met)
Baseline	10.3 (6.4)	2.21 (.12)	15.1 (9.7)	3.53 (.03)	0.08 (.93)	13.3 (8.8)	9.49 (.003)
1-Year follow-up	11.1 (7.8)		15.3 (11.2)			13.7 (10.1)
2-Year follow-up	15.9 (9.4)		21.5 (12.7)			19.4 (11.8)

EHR=electronic health record.
Notes: F statistics and P values were calculated using hierarchical models with pseudo-likelihood estimation to determine whether changes in rates were significant for either EHR or non-EHR practices over time or whether rates of changes differed between the 2 groups over time. Results are unadjusted for covariates.

Table 4

EHR Use and the Quality of Diabetes Care at the 2-Year Follow-up