Electronic Health Records and Quality of Diabetes Care

Cebul, Randall D.; Love, Thomas E.; Jain, Anil K.; Hébert, Caroline

doi:10.1056/nejmsa1102519

Cited by 287 publications

(192 citation statements)

References 19 publications

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“…4 Furthermore, certain MU functionalities such as CPOE, electronic prescribing and clinical decision support have been associated with improvements in care. 2,[23][24][25][26][27][28][29][30] However, the full clinical benefits of MU have yet to be empirically evaluated and warrant future research. Although adoption of many functionalities varied by specialty, adoption of several functionalities associated with e-prescribing significantly increased between 2009 and 2011 across both primary care physicians and specialists.…”

Section: %)mentioning

confidence: 99%

Variation in Electronic Health Record Adoption and Readiness for Meaningful Use: 2008–2011

et al. 2013

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confidence: 99%

Variation in Electronic Health Record Adoption and Readiness for Meaningful Use: 2008–2011

et al. 2013

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“…Several evidence reviews have identified interventions with modest effects in promoting both overall and condition-specific medication adherence. [11][12][13][14][15][16] Given the complex, multifactorial cause of medication non-adherence, interventions can be similarly multifactorial and multi-level. In this paper we focus on the physician-patient level to furnish providers with a guide to applying adherence research in the clinical encounter.…”

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confidence: 99%

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

et al. 2016

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Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decisionmaking for clinicians interested in providing patientcentered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of nonadherence to medications for chronic conditions. A dherence to medications is often suboptimal-up to 50 % of patients do not take their prescribed medication as recommended. 1-4 Medication non-adherence is associated with adverse health outcomes as well as negative social and economic consequences. [5][6][7] The problem of medication nonadherence is often multifaceted and multifactorial; in general, most conceptual models of medication non-adherence take an ecological perspective, and include patient factors (e.g., literacy, cognitive function), provider factors (e.g., complex regimens), social/community factors (e.g., access to providers and pharmacy), health care factors (e.g., interaction with healthcare system, trust, prior authorization, fragmentation), and policy implications (e.g., coverage of medication). 8-10 Thus, to be effective, interventions designed to improve appropriate medication use must adopt a comprehensive approach, often combining numerous proven strategies. Several evidence reviews have identified interventions with modest effects in promoting both overall and condition-specific medication adherence. [11][12][13][14][15][16] Given the complex, multifactorial cause of medication non-adherence, interventions can be similarly multifactorial and multi-level. In this paper we focus on the physician-patient level to furnish providers with a guide to applying adherence research in the clinical encounter.Evidence increasingly demonstrates that adopting a personcentered approach for medication use that incorporates patient beliefs, preferences, goals, and barriers to medication-taking (e.g., cost, technological ability, concerns about medication prescribing and use) leads to better clinical outcomes. 17,18 Clinicians are in a key position to elicit this information from patients and to incorporate it into medication-related decisions, thereby improving medication adherence rates. Person-centered care focuses on providing patients with greater choice, recognizing their roles as consumers of health care who know best their own beliefs and preferences. This care is meant to encourage value concordance-in this case, the match between the treatment that is selected and the treatment that i...

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“…The addition of electronic health records (EHRs) to ongoing quality improvement (QI) efforts has been shown to improve chronic care in large health care organizations [6,7] and in an urban QI collaborative [8]. However, few data document the effects of onsite practice facilitation services that incorporate both QI and the implementation of certified EHRs in small primary care practices, particularly those in rural areas.…”

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confidence: 99%

Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model

Cykert

Lefebvre

Bacon

et al. 2016

North Carolina Medical Journal

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background The effect of practice facilitation that provides onsite quality improvement (QI) and electronic health record (EHR) coaching on chronic care outcomes is unclear. This study evaluates the effectiveness of such a program-similar to an agricultural extension center model-that provides these services. methods Through the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act, the North Carolina Area Health Education Centers program became the Regional Extension Center for Health Information Technology (REC) for North Carolina. The REC program provides onsite technical assistance to help small primary care practices achieve meaningful use of certified EHRs. While pursuing meaningful use functionality, practices were also offered complementary onsite advice regarding QI issues. We followed the first 50 primary care practices that utilized both EHR and QI advice targeting diabetes care. results The achievement of meaningful use of certified EHRs and performance of QI with onsite practice facilitation showed an absolute improvement of 19% in the proportion of patients who achieved excellent diabetes control (hemoglobin A1c < 7%) compared to baseline. In addition, the percentages of patients with poorly controlled diabetes (hemoglobin A1c > 9%) fell steeply in these practices. limitations No control group was available for comparison. conclusion Practice facilitation that provided EHR and QI coaching support showed important improvements in diabetes outcomes in practices that achieved meaningful use of their EHR systems. This approach holds promise as a way to help small primary care practices achieve excellent patient outcomes.

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Electronic Health Records and Quality of Diabetes Care

Abstract: These findings support the premise that federal policies encouraging the meaningful use of EHRs may improve the quality of care across insurance types.

Cited by 287 publications

References 19 publications

Variation in Electronic Health Record Adoption and Readiness for Meaningful Use: 2008–2011

Variation in Electronic Health Record Adoption and Readiness for Meaningful Use: 2008–2011

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model

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