Impact of an electronic medical record on diabetes quality of care
Impact of an electronic medical record on diabetes quality of care
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DOI：
10.1370/afm.327
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发表时间：
2005-07-01
影响因子：
4.4
通讯作者：
Duncan, JE
中科院分区：
文献类型：
--
作者：
O'Connor, PJ;Crain, AL;Duncan, JE
目的本研究旨在评估电子病历（EMR）的实施对糖尿病护理质量的影响。方法我们对122名成年糖尿病患者在干预（EMR）诊所和对照（非EMR）诊所进行了为期5年的纵向研究。诊所也有类似的初级保健医生培训，类似的患者人群，并使用一个共同的糖尿病护理指南，强调血糖控制的重要性。EMR提供基本的决策支持，包括糖尿病护理的提示和提醒。对干预前后糖化血红蛋白（HbA（1c））和低密度脂蛋白（LDL）水平的检测频率进行了比较，并对患者年龄、性别、合并症和基线HbA（1c）水平进行了调整。结果：EMR诊所的HbA（1c）检测频率高于非EMR诊所（P <0.001）。实施EMR后2年（P = 0.10）或4年（P = 0.27），两个诊所的HbA（1c）水平均有所改善（P <0.05），两个诊所之间无显著差异。在这项对照研究中，EMR的使用导致HbA（1c）和LDL测试的数量增加，但没有更好的代谢控制。如果EMR要实现其作为护理改进工具的承诺，可能需要改进的实施策略和更复杂的临床决策支持。
PURPOSE This study was designed to evaluate the impact of electronic medical record (EMR) implementation on quality of diabetes care.METHODS We conducted a 5-year longitudinal study of 122 adults with diabetes mellitus at an intervention (EMR) clinic and a comparison (non-EMR) clinic. Clinics had similarly trained primary care physicians, similar patient populations, and used a common diabetes care guideline that emphasized the importance of glucose control. The EMR provided basic decision support, including prompts and reminders for diabetes care. Preintervention and postintervention frequency of testing for glycated hemoglobin (HbA(1c)) and low-density lipoprotein (LDL) levels were compared with and without adjustment for patient age, sex, comorbidity, and baseline HbA(1c) level.RESULTS Frequency of HbA(1c) tests increased at the EMR clinic compared with the frequency at the non-EMR clinic (P < .001). HbA(1c) levels improved in both clinics (P < .05) with no significant differences between clinics 2 years (P = .10) or 4 years (P = .27) after EMR implementation. Similar results were observed for LDL levels.CONCLUSIONS In this controlled study, EMR use led to an increased number of HbA(1c) and LDL tests but not to better metabolic control. If EMRs are to fulfill their promise as care improvement tools, improved implementation strategies and more sophisticated clinical decision support may be needed.