FULL STUDY .
Although the study claims that those using an EHR saw "significantly higher quality of care for four of the measures: hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening" The effect sizes only ranged from 3 to 13 percentage points per measure."
Electronic health record use was associated with higher performance than paper for: hemoglobin A1c testing in diabetes (90.1 % vs. 84.2 %, p = 0.003), breast cancer screening (78.6 % vs. 74.2 %, p < 0.001), chlamydia screening (65.8 % vs. 53.0 %, p = 0.02) and colorectal cancer screening (51.3 % vs. 48.0 %, p = 0.01). Electronic health record use was associated with higher quality for two other measures, though these were not statistically significant: LDL testing in diabetes (87.6 % vs. 85.1 %, p = 0.26) and nephropathy screening in diabetes (68.2 % vs. 64.8 %, p = 0.33).
Abstract
CONTEXT
The US Federal Government is investing up to $29 billion in incentives for meaningful use of electronic health records (EHRs).
However, the effect of EHRs on ambulatory quality is unclear, with several large studies finding no effect.
OBJECTIVE
To determine the effect of EHRs on ambulatory quality in a community-based setting.
DESIGN
Cross-sectional study, using data from 2008.
SETTING
Ambulatory practices in the Hudson Valley of New York, with a median practice size of four physicians.
PARTICIPANTS
We
included all general internists, pediatricians and family medicine
physicians who: were members of the Taconic Independent
Practice Association, had patients in a data set of
claims aggregated across five health plans, and had at least 30 patients
per measure for at least one of nine quality measures
selected by the health plans.
IINTERVENTION
Adoption of an EHR.
MAIN OUTCOME MEASURES
We compared physicians using EHRs to physicians using paper on performance for each of the nine quality measures, using t-tests.
We also created a composite quality score by standardizing performance
against a national benchmark and averaging
standardized performance across measures. We used
generalized estimation equations, adjusting for nine physician
characteristics.
KEY RESULTS
We
included 466 physicians and 74,618 unique patients. Of the physicians,
204 (44 %) had adopted EHRs and 262 (56 %) were
using paper. Electronic health record use was
associated with significantly higher quality of care for four of the
measures:
hemoglobin A1c testing in diabetes, breast cancer
screening, chlamydia screening, and colorectal cancer screening. Effect
sizes ranged from 3 to 13 percentage points per
measure. When all nine measures were combined into a composite, EHR use
was
associated with higher quality of care (sd 0.4, p = 0.008).
CONCLUSIONS
This
is one of the first studies to find a positive association between EHRs
and ambulatory quality in a community-based setting.
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