The Association Between Personal Health Record Use and Diabetes Quality Measures
The Association Between Personal Health Record Use and Diabetes Quality Measures
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DOI：
10.1007/s11606-011-1889-0
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发表时间：
2012-04-01
影响因子：
5.7
通讯作者：
Hickner, John
中科院分区：
文献类型：
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作者：
Tenforde, Mark;Nowacki, Amy;Hickner, John
电子个人健康记录（PHR）有可能使患者能够自我管理慢性病，这将导致改善的结果。为了测量使用先进的电子医疗记录相关的PHR与糖尿病质量测量之间的关联，在糖尿病（DM）成人中进行回顾性审查PHR使用和多变量回归分析。10，从2008年7月至2009年6月，746名18-75岁的糖尿病成人在克利夫兰诊所的初级保健医生办公室至少就诊两次。糖尿病质量指标为：血红蛋白A1 c（HbA 1c）、低密度脂蛋白胆固醇、血压、体重指数（BMI）、HbA 1c检测、ACEi/ARB使用和/或微量白蛋白检测、肺炎球菌疫苗接种、足部和散瞳眼检查以及吸烟状况。与非使用者相比，PHR使用者更年轻、收入更高、受教育程度更高、更可能被识别为白人，并且具有更好的未经调整和调整的糖尿病质量测量特征。HbA 1c检测的校正比值比为2.06（p < 0.01），最近HbA 1c降低0.29%（p < 0.01）。在PHR使用者中，增加登录天数通常与更有利的糖尿病质量测量概况无关。PHR使用，而不是使用强度，与改善的糖尿病质量测量概况相关。PHR用户中更好的糖尿病概况可能是由于注册PHR的人对其健康的参与程度更高，而不是PHR使用本身。PHR的使用并不频繁。为了实现价值最大化，下一代PHR必须设计成让患者参与日常糖尿病自我管理。
Electronic personal health records (PHRs) have the potential to empower patients in self-management of chronic diseases, which should lead to improved outcomes.To measure the association between use of an advanced electronic medical record-linked PHR and diabetes quality measures in adults with diabetes mellitus (DM).Retrospective audit of PHR use and multivariable regression analyses.10,746 adults 18-75-years of age with DM seen at least twice at the office of their primary care physician at the Cleveland Clinic from July 2008 through June 2009.PHR use was measured as number of use days. Diabetes quality measures were: hemoglobin A1c (HbA1c), LDL cholesterol, blood pressure, body mass index (BMI), HbA1c testing, ACEi/ARB use and/or microalbumin testing, pneumococcal vaccination, foot and dilated eye examination, and smoking status.Compared to non-users, PHR users were younger, had higher incomes and educational attainment, were more likely to identify as Caucasian, and had better unadjusted and adjusted diabetes quality measure profiles. Adjusted odds ratio of HbA1c testing was 2.06 (p < 0.01) and most recent HbA1c was 0.29% lower (p < 0.01). Among PHR users, increasing number of login days was generally not associated with more favorable diabetes quality measure profiles.PHR use, but not intensity of use, was associated with improved diabetes quality measure profiles. It is likely that better diabetes profiles among PHR users is due to higher level of engagement with their health among those registered for the PHR rather than PHR use itself. PHR use was infrequent. To maximize value, next-generation PHRs must be designed to engage patients in everyday diabetes self-management.