Employing the electronic health record to improve diabetes care: a multifaceted intervention in an integrated delivery system.
BACKGROUND
Type 2 diabetes is one of the nation's most prevalent chronic diseases. Although well-known practice guidelines exist, real-life clinical performance often falls short of benchmarks.


OBJECTIVE
Employ an electronic registry derived from a fully integrated electronic health record (EHR) as the cornerstone of an intervention to improve compliance with recommended diabetes performance measures in an integrated practice network.


METHODS
Geisinger Health System's network of 38 practice sites providing care to over 20,000 persons with diabetes located in a 40-county region of central and northeastern Pennsylvania.


METHODS
A multidisciplinary group of physicians worked to create a "bundle" of best practice measures for diabetes. This measurement tool was then used as part of a multifaceted intervention to improve physician performance in diabetes care, including audit and feedback, computerized reminders, and financial incentives. Changes in performance of individual measures and the total "bundle" were tracked monthly over 1 year.


RESULTS
Significant increases were seen in all measures of diabetes care over the 12-month period of the study. Vaccination for pneumococcal disease and influenza improved from 56.5% to 80.8% (p < .0001) and 55.1% to 71.0% (p < .0001), respectively. The percentage of patients with ideal glucose control (HBA1c < 7.0) increased from 32.2% to 34.8% (p < .001), and blood pressure control (<130/80) improved from 39.7% to 43.9% (p < .0001). The overall number of patients receiving all 9 "bundled" measurements improved from 2.4% to 6.5% (p < .0001).


CONCLUSIONS
Diabetes care improved significantly in response to a multifaceted intervention featuring the use of an EHR-derived registry in an integrated delivery system. More work is needed to demonstrate that such improvements will translate into improved patient health outcomes.
Weber
Valerie
V
Department of General Internal Medicine, Geisinger Health System, Danville, PA, USA. vdweber@geisinger.edu
Bloom
Frederick
F
Pierdon
Steve
S
Wood
Craig
C
D000368:Aged; D000555:Ambulatory Care Information Systems; D020000:Decision Support Systems, Clinical; D019033:Delivery of Health Care, Integrated; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D010414:Pennsylvania; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D017010:Reminder Systems