Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.
Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.
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DOI：
10.7326/0003-4819-157-7-201210020-00004
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发表时间：
2012-10-02
影响因子：
39.2
通讯作者：
Jaffe M
中科院分区：
文献类型：
--
作者：
Reed M;Huang J;Graetz I;Brand R;Hsu J;Fireman B;Jaffe M
医生可以收到联邦支付有意义的使用完整的认证电子健康记录（EHR）。关于EHR的使用如何影响临床护理和结果的证据有限。研究使用市售认证的EHR与糖尿病患者的临床护理流程和疾病控制之间的关联。准实验设计，在17个医疗中心依次实施门诊EHR。多变量分析调整了患者特征、医疗中心、时间趋势和患者水平聚类。北方加州的Kaiser Permanente，一个综合的交付系统。169 711例糖尿病患者。使用商业上可获得的认证EHR。药物治疗强化和血红蛋白A1 c（HbA 1c）和低密度脂蛋白胆固醇（LDL-C）检测和数值。在HbA 1c值≥ 9%后，使用EHR与治疗强化的统计学显著改善相关（比值比，1.10 [95% CI，1.06 - 1.14]）或LDL-C值为2.6 - 3.3 mmol/L（100至129 mg/dL）（比值比，1.06 [CI，1.03 ~ 1.09]）;所有患者中HbA 1c和LDL-C水平的365天复检增加，在疾病控制最差的患者中，（HbA 1c ≥9%或LDL-C ≥3.4 mmol/L [ ≥130 mg/dL]）; HbA 1c水平低于7%或LDL-C水平低于2.6 mmol/L（<100 mg/dL）的患者90天复检减少。EHR还与HbA 1c和LDL-C水平的统计学显著性降低相关，在控制最差的患者中降低幅度最大（基线LDL-C ≥3.4 mmol/L [ ≥130 mg/dL]的患者中降低0.06 mmol/L [2.19 mg/dL]; P < 0.001）。EHR是在心血管护理质量指标基线表现较强的环境中实施的。使用市售的经认证的EHR与改善糖尿病患者的药物治疗强化、监测和生理控制相关，在控制较差的患者中改善更大，在已经达到指南推荐的血糖和血脂目标的患者中测试更少。国家糖尿病、消化和肾脏疾病研究所。
Physicians can receive federal payments for meaningful use of complete certified electronic health records (EHRs). Evidence is limited on how EHR use affects clinical care and outcomes. To examine the association between use of a commercially available certified EHR and clinical care processes and disease control in patients with diabetes. Quasi-experimental design with outpatient EHR implementation sequentially across 17 medical centers. Multivariate analyses adjusted for patient characteristics, medical center, time trends, and patient-level clustering. Kaiser Permanente Northern California, an integrated delivery system. 169 711 patients with diabetes mellitus. Use of a commercially available certified EHR. Drug treatment intensification and hemoglobin A1c (HbA1c) and low-density lipoprotein cholesterol (LDL-C) testing and values. Use of an EHR was associated with statistically significant improvements in treatment intensification after HbA1c values of 9% or greater (odds ratio, 1.10 [95% CI, 1.06 to 1.14]) or LDL-C values of 2.6 to 3.3 mmol/L (100 to 129 mg/dL) (odds ratio, 1.06 [CI, 1.03 to 1.09]); increases in 365-day retesting for HbA1c and LDL-C levels among all patients, with the most dramatic change among patients with the worst disease control (HbA1c ≥9% or LDL-C ≥3.4 mmol/L [ ≥130 mg/dL]); and decreased 90-day retesting among patients with HbA1c level less than 7% or LDL-C level less than 2.6 mmol/L (<100 mg/dL). The EHR was also associated with statistically significant reductions in HbA1c and LDL-C levels, with the largest reductions among patients with the worst control (0.06-mmol/L [2.19-mg/dL] reduction among patients with baseline LDL-C ≥3.4 mmol/L [ ≥130 mg/dL]; P < 0.001). The EHR was implemented in a setting with strong baseline performance on cardiovascular care quality measures. Use of a commercially available, certified EHR was associated with improved drug treatment intensification, monitoring, and physiologic control among patients with diabetes, with greater improvements among patients with worse control and less testing in patients already meeting guideline-recommended glycemic and lipid targets. National Institute of Diabetes and Digestive and Kidney Diseases.
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影响因子：
4.4
作者：
O'Connor, PJ;Crain, AL;Duncan, JE
通讯作者：
Duncan, JE
影响因子：
39.2
作者：
Mangione, Carol M.;Gerzoff, Robert B.;Selby, Joe V.
通讯作者：
Selby, Joe V.
影响因子：
2.9
作者：
Costa, Beth M.;Fitzgerald, Kristine J.;Dunning, Trisha A. M.
通讯作者：
Dunning, Trisha A. M.
DOI：
10.1197/jamia.m1788
发表时间：
2005-07-01
影响因子：
6.4
作者：
Sequist, TD;Gandhi, TK;Bates, DW
通讯作者：
Bates, DW
影响因子：
--
作者：
Romano, Max J.;Stafford, Randall S.
通讯作者：
Stafford, Randall S.