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- Page navigation anchor for The missing link between diabetes care provided and patient outcomesThe missing link between diabetes care provided and patient outcomesShow More
The study of O’Connor showed improvements in the care provided, but this was not accompanied by favourable patient outcomes. Other studies, also those that involved very intensive and complex interventions, showed comparable results: favourable effects on the process of care but none or only very moderate effects on achieving strict metabolic control(1). This missing link can be explained by two different reasons: 1) Reg...
Competing Interests: None declared. - Page navigation anchor for We have a way to go!We have a way to go!Show More
O'Conner & Colleagues are to be commended for an excellent study of the impact of the electronic health record (EHR) on diabetes care. Lacking a prospective, randomized prospective trial, the authors did the next best thing: took advantage of a staggered roll-out of the intervention, using a parallel clinic site that - by System (HealthPartners) and patients - appeared to differ only by the presence or absence of th...
Competing Interests: None declared. - Page navigation anchor for Chronic Care ModelChronic Care ModelShow More
Your study is a very valuable addition to support the increasing use of EMR, and demonstrating the obvious (process alone is not enough. Your work will help us avoid less than stellar initiatives in the future.
Have you had any experience with the Chronic Care Model, e.g. Wagner, with a more patient centered focus?
We are designing a system which will allow MD and patient access to an internet-based por...
Competing Interests: None declared. - Page navigation anchor for ACADEMIC DETAILINGACADEMIC DETAILINGShow More
It has been shown by others already that simply knowing the guidelines and having an EMR are not enough to "translate research into practice." Academic detailing, in which a staff is brought to common ground of understanding (and accepting) the guidelines, regular reports of progress and, most important in our offices experience, involving and motivating an entire clinic staff results in better performance on clinical b...
Competing Interests: None declared. - Page navigation anchor for Comment on 'Impact of an Electronic Medical Record on Diabetes Quality of Care'Comment on 'Impact of an Electronic Medical Record on Diabetes Quality of Care'Show More
This excellent study by O’Connor et al yields at least three very important lessons for investigators engaged in research to translate clinical evidence into clinical practice (the so-called “second translational block”, with the first translational block from bench to bedside)(1):
First, the day of the “before-and –after” study design for quality improvement in diabetes is over. Studies using informatics appli...
Competing Interests: None declared. - Page navigation anchor for Comments on O�Connor et al.Comments on O�Connor et al.Show More
Diabetes is already a major public health problem in the United States and the future U.S. diabetes burden is expected to increase dramatically. (1) Fortunately, however, several effective treatments to reduce or prevent diabetes-related complications are available (2), and much effort has gone into the development of evidence-base guidelines for delivery of these treatments. However, the existence of a guideline doe...
Competing Interests: None declared. - Page navigation anchor for EHR-work in progressEHR-work in progressShow More
We were pleased to see that an electronic health record could act effectively as a system for reminding clinicians regarding proper testing as well as proper intervals for testing. As your study so aptly demonstrates, this can work very effectively with an electronic system. We would submit that actually affecting the parameter, in this case hemoglobin A1C is certainly more difficult to achieve and is dependent on man...
Competing Interests: None declared. - Page navigation anchor for Beyond EMR Reminders and AlertsBeyond EMR Reminders and AlertsShow More
O’Connor and colleagues address an important and timely topic—do EMR reminders cause clinicians to treat chronic illness more appropriately? Opportunities to observe controlled comparisons of EMR implementation are rare and valuable. O’Connor et al. deserve our thanks for making the most of one such opportunity.
Despite the technical limitations of O’Connor et al.’s report—very small patient sample size, only...
Competing Interests: None declared. - Page navigation anchor for Comment on 'Impact of an Electronic Medical Record on Diabetes Quality of Care'Comment on 'Impact of an Electronic Medical Record on Diabetes Quality of Care'Show More
O’Connor et al’s careful analysis yields an important message: if the clinical problem is difficult, improving process measures doesn’t get the job done. Their findings are similar to those of Meigs et al (1), who reported that a web-based decision support tool, the “Disease Management Application”, improved measurement of A1c but had little impact on A1c levels.
If process measures are insufficient, what sh...
Competing Interests: None declared.