Associations between healthcare quality and use of electronic health record functions in ambulatory care
Associations between healthcare quality and use of electronic health record functions in ambulatory care
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DOI：
10.1093/jamia/ocv030
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发表时间：
2015-07-01
影响因子：
6.4
通讯作者：
Kaushal, Rainu
中科院分区：
文献类型：
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作者：
Ancker, Jessica S.;Kern, Lisa M.;Kaushal, Rainu
现代电子健康记录（EHR）提供了各种各样的功能，创造了机会，以不同的方式影响医疗质量。本研究的目的是评估医生使用个人电子病历功能和医疗质量之间的关系。材料和方法65个供应商符合“有意义的使用”。从研究期间的门诊访视记录中提取数据（183 095次访视，61 977例患者）。三个EHR功能被认为是潜在的预测因素：接受最佳实践警报，使用订单集和查看面板级报告。十八个临床质量措施从“有意义的使用”programs.Results条件特定的最佳实践警报和订单集的使用与更好的分数临床质量措施捕获过程中糖尿病，癌症筛查，戒烟，肺炎疫苗接种。例如，使用烟草相关警报的中位数以上的供应商在戒烟干预指标上的表现更高（中位数80.6%对66.7%; P< .001），使用糖尿病订单集的中位数以上的供应商在糖尿病低密度脂蛋白（LDL）测试中的质量更高（68.2%对59.5%; P== .001）。对结果的事后检查表明，积极的关联与医疗保健过程的措施有关（如低密度脂蛋白检测率），而与医疗保健结果的测量没有正相关性（如LDL水平）。讨论在使用单一EHR的门诊环境中的初级保健提供者中，通过电子报告的“有意义的使用”质量指标的表现来衡量，密集使用某些EHR功能与增加对推荐护理的依从性相关。这项研究是相关的现行政策，因为它使用的质量指标构建当代认证的电子病历技术，和定量的电子病历使用指标，而不是自我报告的use.Conclusion在早期阶段的“有意义的使用”程序，使用特定的电子病历功能与医疗保健过程指标的性能更高。
Objectives Contemporary electronic health records (EHRs) offer a wide variety of features, creating opportunities to influence healthcare quality in different ways. This study was designed to assess the relationship between physician use of individual EHR functions and healthcare quality.Materials and Methods Sixty-five providers eligible for "meaningful use" were included. Data were abstracted from office visit records during the study timeframe (183 095 visits with 61 977 patients). Three EHR functions were considered potential predictors: acceptance of best practice alerts, use of order sets, and viewing panel-level reports. Eighteen clinical quality measures from the "meaningful use" program were abstracted.Results Use of condition-specific best-practice alerts and order sets was associated with better scores on clinical quality measures capturing processes in diabetes, cancer screening, tobacco cessation, and pneumonia vaccination. For example, providers above the median in use of tobacco-related alerts had higher performance on tobacco cessation intervention metrics (median 80.6% vs. 66.7%; P< .001), and providers above the median in use of diabetes order sets had higher quality on diabetes low density lipoprotein (LDL) testing (68.2% vs. 59.5%; P== .001). Post hoc examination of the results showed that the positive associations were with measures of healthcare processes (such as rates of LDL testing), whereas there were no positive associations with measures of healthcare outcomes (such as LDL levels).Discussion Among primary care providers in the ambulatory setting using a single EHR, intensive use of certain EHR functions was associated with increased adherence to recommended care as measured by performance on electronically reported "meaningful use" quality measures. This study is relevant to current policy as it uses quality metrics constructed by contemporary certified EHR technology, and quantitative EHR use metrics rather than self-reported use.Conclusion In the early stages of the "meaningful use" program, use of specific EHR functions was associated with higher performance on healthcare process metrics.