NEW ORLEANS — Electronic health records did not improve physician adherence to evidence-based diabetes guidelines in a study of primary care practices.
The 37 practices without electronic health records (EHRs) provided equal or better diabetes care than the 17 with the technology, “but there is much room for improvement in both groups,” Jesse C. Crosson, Ph.D., said at the annual conference of the Society of Teachers of Family Medicine.
Information technology is recommended to improve quality of care, but EHR capabilities are unevenly used in primary care. Successful integration of EHRs depend on organizational factors and how well physicians communicate with each other, said Dr. Crosson of the department of family medicine at New Jersey Medical School, Newark.
Practices strongly oriented toward patient care, characterized by relatively open scheduling and physicians who are easy to contact, are more likely to optimize use of EHRs. Practices with a greater focus on money and the bottom line, and with longer wait times for patients, tend to integrate EHRs less well, he said.
The researchers focused on type 2 diabetes because clinical care is complex and treatment guidelines are interrelated, Dr. Crosson said. He and his associates reviewed the charts of 1,080 randomly selected diabetes patients—20 patients each from 54 primary care practices in New Jersey and Pennsylvania. There were no significant differences between EHR and non-EHR practices in terms of number of physicians, number of exam rooms, years in practice, or type of practice.
There were no statistically significant differences in diabetes management between practices with or without EHRs. In multivariate analyses, nonEHR practices did better in assessment, medication management, and outcome targets. The targets were LDL cholesterol below 100 mg/dL, hemoglobin A1c below 7%, and blood pressure below 130/85 mm Hg.
All practices in the study could do better regarding diabetes assessment, Dr. Crosson said. Overall, 52% of participants met three out of these five criteria:
▸ HbA1c tested in the last 6 months.
▸ Microalbumin tested in last 12 months.
▸ Smoking assessment documented.
▸ LDL cholesterol tested in last 12 months.
▸ Blood pressure assessed at every visit.
The study was retrospective, so there could have been selection biases. Also, “we were really limited to what was in the medical record. We do not have income, race, or insurance status,” he said.