title: The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study.
abstract: OBJECTIVE
  To determine the impact of a physician-directed, multifaceted health information technology (HIT) system on diabetes outcomes.
  
  
  METHODS
  A pre/post-interventional study.
  
  
  METHODS
  The setting was Providence Primary Care Research Network in Oregon, with approximately 71 physicians caring for 117 369 patients in 13 clinic locations. The study covered Network patients with diabetes age 18 years and older.
  
  
  METHODS
  The study intervention included implementation of the CareManager HIT system which augments an electronic medical record (EMR) by automating physician driven quality improvement interventions, including point-of-care decision support and care reminders, diabetes registry with care prompts, performance feedback with benchmarking and access to published evidence and patient educational materials.
  
  
  METHODS
  The primary clinical measures included the change in mean value for low density lipoprotein (LDL) target <100 mg/dL or 2.6 mmol/l, blood pressure (BP) target <130/80 mmHg and glycated haemoglobin (HbA1c) target <7%, and the proportion of patients meeting guideline-recommended targets for those measures. All measures were analysed using closed and open cohort approaches.
  
  
  RESULTS
  A total of 6072 patients were identified at baseline, 70% of whom were continuously enrolled during the 24-month study. Significant improvements were observed in all diabetes related outcomes except mean HbA1c. LDL goal attainment improved from 32% to 56% (P=0.002), while mean LDL decreased by 13 mg/dL (0.33 mmol/l, P=0.002). BP goal attainment increased significantly from 30% to 52%, with significant decreases in both mean systolic and diastolic BP. The proportion of patients with an HbA1c below 7% was higher at the end of the study (P=0.008). Mean patient satisfaction remained high, with no significant difference between baseline and follow-up. Total Relative Value Units per patient per year significantly increased as a result of an increase in the number of visits in year one and the coding complexity throughout.
  
  
  CONCLUSIONS
  Implementation of a physician-directed, multifaceted HIT system in primary care was associated with significantly improved diabetes process and outcome measures.
authors.affiliation: Providence Health and Services, Portland, OR 97005, USA. Jacquelyn.Hunt@providence.org
authors.forename: Jacquelyn S
authors.initials: JS
authors.lastname: Hunt
authors.forename: Joseph
authors.initials: J
authors.lastname: Siemienczuk
authors.forename: William
authors.initials: W
authors.lastname: Gillanders
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: LeBlanc
authors.forename: Yelena
authors.initials: Y
authors.lastname: Rozenfeld
authors.forename: Kerry
authors.initials: K
authors.lastname: Bonin
authors.forename: Ginger
authors.initials: G
authors.lastname: Pape
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007256:Information Systems / Q000458:organization & administration* / Q000706:statistics & numerical data; D008297:Male; D016347:Medical Records Systems, Computerized / Q000458:organization & administration / Q000706:statistics & numerical data; D009819:Office Visits; D009922:Oregon; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction; D019095:Point-of-Care Systems / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D017010:Reminder Systems
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin