Impact of Health IT Implementation on Diabetes Process and Outcome Measures

描述（由申请人提供）：本项目的主要目的是量化市售动态电子医疗记录（EHR）对糖尿病护理质量的影响，通过在大量初级保健实践中遵守推荐的护理过程和患者结局指标来衡量。该研究将在Baylor Health Care System（BHCS）HealthTexas Provider Network（HTPN）中进行，该网络在其>100个实践中包括34个合格的初级保健实践，其中大多数是10名或更少的医生。HTPN于2006年5月开始推出其EHR，但因实践而错开。主要目的是测试EHR在自然环境中对糖尿病患者护理的短期和长期影响，如使用Health Partners“最佳糖尿病护理”综合指标（HbA 1c < 8%; LDL胆固醇< 100 mg/dL;血压< 130/80 mmHg;患者服用阿司匹林处方e40岁;不吸烟）所测量的。本研究将使用回顾性病历稽查数据，对约14，000例成人患者进行长达5年的随访，通过10个连续的半年患病率队列，使用美国医学会（AMA）医师联盟成人糖尿病核心医师绩效测量集收集。次要目的将检验以下假设：实施EHR将（1）改变符合每个中间患者结局指标推荐水平的患者比例（HbA 1c、总胆固醇、LDL胆固醇、甘油三酯、血压）;（2）改变遵守个人推荐的糖尿病相关护理流程的患者比例（HbA 1c检测、血脂检查、微量白蛋白尿检测、散瞳视网膜眼科检查、完整足部检查、处方阿司匹林、流感疫苗接种、戒烟咨询），收集于AMA医师联盟成人糖尿病核心测量集;和（3）与HbA 1c水平、胆固醇、甘油三酯和血压的绝对水平的临床上有意义的变化相关，这些变化可能不能通过“与推荐水平的依从性”测量来捕获。此外，由于有必要考虑疾病特定功能的可用性和使用，以及EHR的整体存在/使用，在评估对护理质量的影响时，本项目将估计医生自愿使用HTPN EHR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患者结局的影响，通过最佳糖尿病护理措施进行测量。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性能数据，我们将有>90%的把握度来检测最佳糖尿病护理组合中每个结局指标的6%绝对变化。这项研究将提供有关EHR提高糖尿病护理质量的潜力的重要信息，包括有关疾病特异性EHR组件的潜力和需求的见解，以实现改善。 公共卫生相关性：糖尿病是一种日益常见的慢性疾病，需要长期管理。目前，为糖尿病患者提供的医疗保健福尔斯达不到循证临床指南中建立的“最佳护理”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中包含的功能以及其实践实施电子健康记录的医生使用这些功能存在很大差异;本项目解决了一些更先进的功能/疾病特定工具的使用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.