The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care
The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care
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DOI：
10.7326/m13-1798
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发表时间：
2014-06-03
影响因子：
39.2
通讯作者：
Kaushal, Rainu
中科院分区：
文献类型：
--
作者：
Kern, Lisa M.;Edwards, Alison;Kaushal, Rainu
背景：以病人为中心的医疗之家（PCMH）模式的初级保健正在广泛实施，但其对质量的影响尚不清楚。PCMH通常涉及电子健康记录（EHRs），组织实践的变化，和支付改革.Objective：比较在PCMH的医生提供的医疗质量与医生使用纸质病历，并分别与医生使用EHRs提供的没有PCMH（以确定是否影响驱动EHRs）.Design：前瞻性队列研究（2008年至2010年）。（ClinicalTrials.gov：NCT 00793065）。设置：哈德逊谷，一个7县，多付款人，多供应商地区在纽约。参与者：675名初级保健医生在312个做法和143489例。测量：索赔的10个质量措施，从医疗保健效果数据和信息集。质量的差异确定使用广义估计方程调整为8个医生的特点和4个病人的特点。结果：PCMH组改善显着超过无论是纸组或EHR组随着时间的推移，为4的10项措施（每项措施增加1至9个百分点）：糖尿病患者的眼部检查和血红蛋白A（1c）检测、衣原体筛查和结直肠癌筛查（每项均校正P < 0.05）。PCMH组的总体质量改善的几率比论文组高7%，比EHR组高6%（每个组的校正P < 0.01）。限制：本研究是观察性的，不能排除不可测量的混杂因素的可能性。结论：PCMH与适度的质量改善相关。推动改进的PCMH的方面与EHR不同，但可以由EHR实现。
Background: The patient-centered medical home (PCMH) model of primary care is being implemented widely, although its effects on quality are unclear. The PCMH typically involves electronic health records (EHRs), organizational practice change, and payment reform.Objective: To compare quality of care provided by physicians in PCMHs with that provided by physicians using paper medical records and, separately, with that provided by physicians using EHRs without the PCMH (to determine whether effects were driven by EHRs).Design: Prospective cohort study (2008 to 2010). (ClinicalTrials.gov: NCT00793065).Setting: The Hudson Valley, a 7-county, multipayer, multiprovider region in New York.Participants: 675 primary care physicians in 312 practices and 143 489 patients.Measurements: Claims for 10 quality measures from the Healthcare Effectiveness Data and Information Set were used. Differences in quality were determined using generalized estimating equations adjusted for 8 physician characteristics and 4 patient characteristics.Results: The PCMH group improved significantly more over time than either the paper group or the EHR group for 4 of the 10 measures (by 1 to 9 percentage points per measure): eye examinations and hemoglobin A(1c) testing for patients with diabetes, chlamydia screening, and colorectal cancer screening (adjusted P < 0.05 for each). The odds of overall quality improvement in the PCMH group were 7% higher than in the paper group and 6% higher than in the EHR group (adjusted P < 0.01 for each).Limitation: This study was observational, and the possibility of unmeasured confounders cannot be excluded.Conclusion: The PCMH was associated with modest quality improvement. The aspects of the PCMH that drive improvement are distinct from but may be enabled by the EHR.