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

Article Figures & Data

Table 1.

Components of Guideline Adherence Scores

Processes of Care Any 3 of 5	Treatment All Required	Outcomes Evaluated Both as 2 of 3 and as All Required*
HgA_1c = glycosylated hemoglobin, percentage of total hemoglobin; LDL = low-density lipoprotein cholesterol.
* For outcome measures the most recent recorded value was used.
HgA_1c assessed within last 6 months  Urine microalbumin assessed within last 12 months  Smoking status assessed within last 6 months	HgA_1c ≤8% or >8% and on hypoglycemic agent	HgA_1c <7%
LDL assessed within last 12 months	LDL ≤100 mg/dL or >100 mg/dL and on lipid-lowering agent	LDL ≤100 mg/dL
Blood pressure recorded at each of 3 previous visits	Blood pressure ≤130/85 mm Hg (systolic and diastolic) or >130/85 mm Hg (systolic or diastolic) and on antihypertensive medication	Blood pressure ≤130/85 mm Hg (systolic and diastolic)

Table 2.

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

Characteristic	EMR Practices	Non-EMR Practices	Test Statistic	P 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 patients	257	670
Mean age, y (SD)	57.3 (15.1)	60.7 (14.4)	9.86^†	.002
Sex, %			2.04^†	.15
Women	53.9	48.7
Men	46.1	51.3
No. of practices	13	37
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 practice	7.7 (1)	18.9 (7)
Group practice	92.3 (12)	81.1 (30)
Practice ownership, % (n)			-	.32^§
Physician	53.8 (7)	70.3 (26)
Health system/other	46.2 (6)	29.7 (11)

Table 3.

Practice Percentages of Patients Whose Care Meets Quality Standards

Variable	EMR 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)

Table 4.

Practice and Patient Characteristics Associated With Diabetes Care Quality

Characteristics	Adjusted Odds Ratio	P Value	95% 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/EMR	2.25	<.001	1.42–3.57
Solo practice/other	0.38	.02	0.17–0.87
Physician owned/other	1.03	.90	0.65–1.62
Staff/clinician ratio	1.03	.66	0.91–1.17
Patient sex, male/female	1.21	.22	0.89–1.62
Patient age in 10-year increments	1.02	.68	0.92–1.13
Treatment
No EMR/EMR	1.67	.02	1.07–2.60
Solo practice/other	0.63	.04	0.41–0.98
Physician owned/other	1.03	.89	0.70–1.50
Staff/clinician ratio	1.01	.86	0.89–1.16
Patient sex, male/female	1.06	.74	0.77–1.45
Patient age in 10-year increments	1.27	<.001	1.14–1.41
Outcomes 2 of 3
No EMR/EMR	1.67	<.001	1.25–2.24
Solo practice/other	0.61	.11	0.33–1.12
Physician owned/other	1.44	.02	1.05–1.96
Staff/clinician ratio	1.08	.08	0.96–1.18
Patient sex, male/female	1.36	.02	1.07–1.72
Patient age in 10-year increments	1.11	.03	1.01–1.22
Outcome all
No EMR/EMR	2.68	.001	1.49–4.82
Solo practice/other	0.93	.85	0.45–1.94
Physician owned/other	1.43	.30	0.73–2.78
Staff/clinician ratio	0.96	.50	0.86–1.08
Patient sex, male/female	1.40	.17	0.87–2.25
Patient age in 10-year increments	1.19	.04	1.01–1.42