Impact of Health IT Implementation on Diabetes Process and Outcome Measures

描述（由申请人提供）：本项目的主要目标是量化市售电子医疗记录（EHR）对糖尿病护理质量的影响，通过对推荐护理过程的依从性和患者结果测量来衡量，在一大批初级保健实践中。该研究将在贝勒医疗保健系统（BHCS）德克萨斯健康提供者网络（HTPN）中进行，该网络包括34个合格的初级保健实践，在其bb100实践中，大多数是10个或更少的医生。2006年5月，HTPN开始推出电子病历，但在实践中出现了一些问题。主要目的是测试EHR在自然环境下对糖尿病患者护理的短期和长期影响，使用健康伙伴“最佳糖尿病护理”复合测量（HbA1c < 8%；低密度脂蛋白胆固醇< 100 mg/dL；血压< 130/80 mmHg； 40岁以上患者阿司匹林处方；不吸烟）。该研究将使用回顾性图表审计数据，通过10个连续半年的流行队列，对大约14000名成年患者进行长达5年的随访，收集使用美国医学协会（AMA）医师联盟成人糖尿病核心医师绩效测量集。次要目的将检验以下假设：实施电子健康档案将(1)改变达到推荐水平的患者比例（HbA1c、总胆固醇、LDL胆固醇、甘油三酯、血压）；(2)改变AMA医师联盟成人糖尿病核心措施集中收集的个人推荐的糖尿病相关护理过程（HbA1c检查、血脂检查、微量白蛋白尿检查、扩张视网膜眼科检查、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；(3)与HbA1c水平、胆固醇、甘油三酯和血压绝对水平的临床有意义的变化有关，这些变化可能无法通过“符合推荐水平”的措施来捕捉。此外，在评估对护理质量的影响时，除了EHR的总体存在/使用情况外，还需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 EHR中嵌入的糖尿病管理表的流行程度，以及糖尿病管理表的使用对患者结果的影响，这些影响是通过最佳糖尿病护理测量来衡量的。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表现数据，我们将有大约90%的能力在最佳糖尿病护理组合中检测到每个结果测量值的6%的绝对变化。本研究将提供关于电子病历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病历组件的潜力和需求的见解，以实现改善。

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.