Impact of Health IT Implementation on Diabetes Process and Outcome Measures

描述(由申请人提供)：该项目的主要目标是量化商业上可获得的动态电子医疗记录(EHR)对糖尿病护理质量的影响，通过在一大批初级保健实践中遵守建议的护理过程和患者结果衡量标准来衡量。这项研究将在贝勒医疗保健系统(BHCS)医疗服务提供者网络(HTPN)中进行，该网络将34家符合条件的初级保健诊所纳入其100家诊所，其中大部分是10名或更少的医生。HTPN在2006年5月开始推出其电子病历，但由于实践而步履蹒跚。主要目的是测试EHR在自然环境下对糖尿病患者的护理的短期和长期效果，使用Health Partners“最佳糖尿病护理”综合衡量标准(HbA1c和lt；8%；低密度脂蛋白；100 mg/dL；血压和lt；130/80毫米汞柱；阿司匹林处方E40年；以及不吸烟)进行衡量。这项研究将使用回顾图表审计数据，对大约14,000名成年患者进行长达5年的跟踪调查，通过10个连续的半年度患病率队列，使用美国医学会(AMA)医生联盟成人糖尿病核心医生绩效衡量集收集。二级目标将检验以下假设：实施电子健康记录将(1)改变每项中间患者结局指标(HbA1c、总胆固醇、低密度脂蛋白胆固醇、甘油三酯、血压)的推荐水平的患者比例；(2)改变符合AMA医师联盟成人糖尿病核心衡量标准集中收集的个人推荐的糖尿病相关护理过程(HbA1c测试、血脂面板、微量蛋白尿测试、视网膜扩张眼科检查、完整足部检查、处方阿司匹林、流感疫苗接种、戒烟咨询)的患者比例；以及(3)与HbA1c水平、胆固醇、甘油三酯和血压的绝对水平的临床有意义的变化有关，这些变化可能不会被“遵循推荐水平”的衡量标准所捕捉到。此外，由于在评估对护理质量的影响时，除了电子病历的整体存在/使用之外，有必要考虑特定疾病功能的可用性和利用率，本项目将评估医生自愿使用HTPN电子病历中嵌入的糖尿病管理表的流行率，以及糖尿病管理表的使用对以最佳糖尿病护理措施衡量的患者结局的影响。考虑到研究人群的规模和在拟议项目的初步研究中收集的基线绩效数据，我们将拥有90%的权力来检测最佳糖尿病护理组合中每个结果指标6%的绝对变化。这项研究将提供有关电子健康记录改善糖尿病护理质量的潜力的重要信息，包括对特定疾病的电子健康记录组件的潜力和改善效果的需求的洞察。 公共卫生相关性：糖尿病是一种越来越常见的慢性病，需要长期治疗。目前，向糖尿病患者提供的医疗保健‘没有达到循证临床指南中确立的’最佳保健‘实践。这项研究将提供有关糖尿病护理质量变化的重要信息，这些信息可以合理地预期在初级保健实践中实施电子健康记录。此外，由于商业上可用的电子健康记录系统所包含的功能和实施电子健康记录的医生对这些功能的使用都有很大的不同；该项目解决了使用一些更先进的功能/针对疾病的工具如何影响糖尿病护理的问题。

DESCRIPTION (provided by applicant): The primary objective of this project is to quantify the effects of a commercially-available ambulatory electronic healthcare record (EHR) on quality of diabetes care, as measured by compliance with recommended processes of care and patient outcome measures, in a large group of primary care practices. The study will be conducted in the Baylor Health Care System (BHCS) HealthTexas Provider Network (HTPN) which includes 34 eligible primary care practices within its >100 practices, mostly with 10 or fewer physicians. HTPN began rolling out its EHR, staggered by practice, in May 2006. The primary aim is to test the short and long-term effects of the EHR on the care of diabetes patients in a naturalistic setting, as measured using the Health Partners "Optimal Diabetes Care" composite measure (HbA1c < 8%; LDL cholesterol < 100 mg/dL; Blood pressure < 130/80 mmHg; Aspirin prescription in patients e40 years; and, Not smoking). The study will use retrospective chart audit data on approximately 14,000 adult patients followed for up to 5 years through 10 successive semi-annual prevalence cohorts, collected using the American Medical Association (AMA) Physician Consortium Adult Diabetes Core Physician Performance Measurement Set. Secondary Aims will test the hypotheses that implementing an EHR will (1) change the proportion of patients meeting the recommended levels for each of the intermediate patient outcome measures (HbA1c, total cholesterol, LDL cholesterol, triglycerides, blood pressure); (2) change the proportion of patients in compliance with the individual recommended diabetes-related processes of care (HbA1c test, lipid panel, test for microalbuminuria, dilated retinal eye exam, complete foot exam, prescribed aspirin, influenza vaccination, smoking cessation counseling) collected in the AMA Physician Consortium Adult Diabetes Core Measure Set; and (3) be associated with clinically meaningful changes in the absolute levels of HbA1c level, cholesterol, triglycerides and blood pressure that may not be captured by the "compliance with recommended levels" measures. Additionally, as it is necessary to consider the availability and utilization of disease-specific functionalities, in addition to the overall presence/use of the EHR, in evaluating the impact on quality of care, this project will estimate the prevalence of voluntary physician use of the Diabetes Management Form embedded within the HTPN EHR, and the effect of Diabetes Management Form use on patient outcomes as measured by the Optimal Diabetes Care measure. Given the size of the study population and baseline performance data collected in the preliminary studies for the proposed project, we will have >90% power to detect a 6% absolute change in each the outcome measures within the Optimal Diabetes Care composite. This study will provide important information about the potential for an EHR to improve quality of diabetes care, including insight regarding the potential of and need for disease-specific EHR components to effect improvement. PUBLIC HEALTH RELEVANCE: Diabetes is an increasingly common chronic disease that requires long-term management. Currently, the health care provided to diabetes patients' falls short of the 'best care' practices established in evidence-based clinical guidelines. This research will provide important information about the changes in quality of diabetes care that can reasonably be expected with the implementation of electronic health records in primary care practices. Furthermore, since there is wide variation in both the functions included in the electronic health record systems available commercially and in the use of these functions by physicians whose practices implement electronic health records; this project addresses the question of how use of some of the more advanced functions/disease-specific tools impacts diabetes care.