title: Electronic medical records and diabetes quality of care: results from a sample of family medicine practices.
abstract: OBJECTIVE
  Care of patients with diabetes requires management of complex clinical information, which may be improved by the use of an electronic medical record (EMR); however, the actual relationship between EMR usage and diabetes care quality in primary care settings is not well understood. We assessed the relationship between EMR usage and diabetes care quality in a sample of family medicine practices.
  
  
  METHODS
  We conducted cross-sectional analyses of baseline data from 50 practices participating in a practice improvement study. Between April 2003 and December 2004 chart auditors reviewed a random sample of medical records from patients with diabetes in each practice for adherence to guidelines for diabetes processes of care, treatment, and achievement of intermediate outcomes. Practice leaders provided medical record system information. We conducted multivariate analyses of the relationship between EMR usage and diabetes care adjusting for potential practice- and patient-level confounders and practice-level clustering.
  
  
  RESULTS
  Diabetes care quality in all practices showed room for improvement; however, after adjustment, patient care in the 37 practices not using an EMR was more likely to meet guidelines for process (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.42-3.57) treatment (OR, 1.67; 95% CI, 1.07-2.60), and intermediate outcomes (OR, 2.68; 95% CI, 1.49-4.82) than in the 13 practices using an EMR.
  
  
  CONCLUSIONS
  The use of an EMR in primary care practices is insufficient for insuring high-quality diabetes care. Efforts to expand EMR use should focus not only on improving technology but also on developing methods for implementing and integrating this technology into practice reality.
authors.affiliation: Department of Family Medicine, UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA. jesse.crosson@umdnj.edu
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Crosson
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ohman-Strickland
authors.forename: Karissa A
authors.initials: KA
authors.lastname: Hahn
authors.forename: Barbara
authors.initials: B
authors.lastname: DiCicco-Bloom
authors.forename: Eric
authors.initials: E
authors.lastname: Shaw
authors.forename: A John
authors.initials: AJ
authors.lastname: Orzano
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies