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Research ArticleOriginal Research

Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices

Jesse C. Crosson, Pamela A. Ohman-Strickland, Karissa A. Hahn, Barbara DiCicco-Bloom, Eric Shaw, A. John Orzano and Benjamin F. Crabtree
The Annals of Family Medicine May 2007, 5 (3) 209-215; DOI: https://doi.org/10.1370/afm.696
Jesse C. Crosson
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Pamela A. Ohman-Strickland
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Karissa A. Hahn
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Barbara DiCicco-Bloom
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Eric Shaw
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A. John Orzano
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Benjamin F. Crabtree
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Article Figures & Data

Tables

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    Table 1.

    Components of Guideline Adherence Scores

    Processes of Care Any 3 of 5Treatment All RequiredOutcomes Evaluated Both as 2 of 3 and as All Required*
    HgA1c = glycosylated hemoglobin, percentage of total hemoglobin; LDL = low-density lipoprotein cholesterol.
    * For outcome measures the most recent recorded value was used.
    HgA1c assessed within last 6 months
 Urine microalbumin assessed within last 12 months
 Smoking status assessed within last 6 monthsHgA1c ≤8% or >8% and on hypoglycemic agentHgA1c <7%
    LDL assessed within last 12 monthsLDL ≤100 mg/dL or >100 mg/dL and on lipid-lowering agentLDL ≤100 mg/dL
    Blood pressure recorded at each of 3 previous visitsBlood pressure ≤130/85 mm Hg (systolic and diastolic) or >130/85 mm Hg (systolic or diastolic) and on antihypertensive medicationBlood pressure ≤130/85 mm Hg (systolic and diastolic)
    • View popup
    Table 2.

    Patient (N = 927) and Practice (N = 50) Characteristics

    CharacteristicEMR PracticesNon-EMR PracticesTest StatisticP Value*
    EMR = electronic medical record.
    * Bonferroni adjusted significance level P ≤.007.
    † Hierarchical model, Wald test statistic.
    ‡ Analysis of variance, degrees of freedom = 1, 48.
    § Fisher exact test.
    No. of patients257670
    Mean age, y (SD)57.3 (15.1)60.7 (14.4)9.86†.002
    Sex, %2.04†.15
        Women53.948.7
        Men46.151.3
    No. of practices1337
    No. of clinicians, mean (SD)4.5 (3.2)4.7 (3.2)0.02‡.89
    No. of staff, mean (SD)10.2 (8.7)14.9 (10.9)1.92‡.17
    Staff/clinician ratio (SD)2.3 (1.6)3.2 (1.6)3.35‡.07
    Practice type, % (n)-.66§
        Solo practice7.7 (1)18.9 (7)
        Group practice92.3 (12)81.1 (30)
    Practice ownership, % (n)-.32§
        Physician53.8 (7)70.3 (26)
        Health system/other46.2 (6)29.7 (11)
    • View popup
    Table 3.

    Practice Percentages of Patients Whose Care Meets Quality Standards

    VariableEMR Practices (n=13) Mean (SD)Non-EMR Practices (n=37) Mean (SD)
    EMR = emergency medical record.
    Processes of care (3 of 5 guidelines met)35.0 (19.5)53.8 (22.1)
    Treatment (all guidelines met)35.3 (16.9)48.6 (15.7)
    Outcome targets (2 of 3 guidelines met)29.0 (11.7)43.7 (15.4)
    Outcome targets (all guidelines met)3.9 (3.8)10.7 (9.0)
    • View popup
    Table 4.

    Practice and Patient Characteristics Associated With Diabetes Care Quality

    CharacteristicsAdjusted Odds RatioP Value95% CI
    CI = confidence interval; EMR = electronic medical record.
    Note: These odds ratios are obtained from a single regression model for each outcome such that the odds ratios are adjusted for all other covariates in the table.
    Processes of care
        No EMR/EMR2.25<.0011.42–3.57
        Solo practice/other0.38.020.17–0.87
        Physician owned/other1.03.900.65–1.62
        Staff/clinician ratio1.03.660.91–1.17
        Patient sex, male/female1.21.220.89–1.62
        Patient age in 10-year increments1.02.680.92–1.13
    Treatment
        No EMR/EMR1.67.021.07–2.60
        Solo practice/other0.63.040.41–0.98
        Physician owned/other1.03.890.70–1.50
        Staff/clinician ratio1.01.860.89–1.16
        Patient sex, male/female1.06.740.77–1.45
        Patient age in 10-year increments1.27<.0011.14–1.41
    Outcomes 2 of 3
        No EMR/EMR1.67<.0011.25–2.24
        Solo practice/other0.61.110.33–1.12
        Physician owned/other1.44.021.05–1.96
        Staff/clinician ratio1.08.080.96–1.18
        Patient sex, male/female1.36.021.07–1.72
        Patient age in 10-year increments1.11.031.01–1.22
    Outcome all
        No EMR/EMR2.68.0011.49–4.82
        Solo practice/other0.93.850.45–1.94
        Physician owned/other1.43.300.73–2.78
        Staff/clinician ratio0.96.500.86–1.08
        Patient sex, male/female1.40.170.87–2.25
        Patient age in 10-year increments1.19.041.01–1.42

Additional Files

  • Tables
  • The Article in Brief

    Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices

    Jesse C. Crosson, PhD , and colleagues

    Background Electronic medical records (EMRs) can help medical practices manage complex information for patients with diseases such as diabetes. This study looks at the relationship between the use of an EMR and the quality of diabetes care in family medicine practices.

    What This Study Found Practices that used electronic medical records were less likely to meet measures for diabetes quality of care than practices without EMRs. This finding might be due to differences in features of the EMR, the degree to which clinicians used the EMR, and resources available to support these efforts.

    Implications

    • Having an electronic medical record does not guarantee that quality of care will improve. More study is needed to determine how EMRs can help support quality of care for patients with chronic illnesses such as diabetes.
    • Policy makers and primary care practice owners should consider how to maintain and improve quality both during and after the implementation of an EMR.
    • EMR companies should be encouraged to develop products with easy-to-use features that support improved health care quality in primary care practices.
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The Annals of Family Medicine: 5 (3)
The Annals of Family Medicine: 5 (3)
Vol. 5, Issue 3
1 May 2007
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Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices
Jesse C. Crosson, Pamela A. Ohman-Strickland, Karissa A. Hahn, Barbara DiCicco-Bloom, Eric Shaw, A. John Orzano, Benjamin F. Crabtree
The Annals of Family Medicine May 2007, 5 (3) 209-215; DOI: 10.1370/afm.696

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Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices
Jesse C. Crosson, Pamela A. Ohman-Strickland, Karissa A. Hahn, Barbara DiCicco-Bloom, Eric Shaw, A. John Orzano, Benjamin F. Crabtree
The Annals of Family Medicine May 2007, 5 (3) 209-215; DOI: 10.1370/afm.696
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