Effect of a patient panel-support tool on care delivery.
OBJECTIVE
To evaluate the effect of a patient panel-support tool (PST) on care delivery for diabetes mellitus (DM) and cardiovascular disease (CVD).


METHODS
Retrospective longitudinal cohort study among primary care providers (PCPs), with 2005 as the preintervention, 2006 as the implementation, and 2007 as the postintervention period.


METHODS
We estimated the intervention effect using electronic medical record data and hierarchical linear models. The intervention was a PST displaying "care gaps" and recommendations for glycosylated hemoglobin, low-density lipoprotein cholesterol, and blood pressure screening and control; retinopathy, nephropathy, and foot screening; aspirin, statin, and angiotensin-converting enzyme inhibitor or beta-blocker use; and influenza and pneumococcal vaccination. Participants were qualifying PCPs and health maintenance organizations; patients. Patients had DM or CVD and 12 months of membership (n = 30,273 DM; 26,414 CVD). Main measures were mean percentages of care recommendations that were met by PCPs per patient per month (the care score).


RESULTS
From 2005 to 2007, the mean care score (95% confidence interval) increased for both DM and CVD, from 63.5 (62.7, 64.3) to 70.6 (69.8, 71.4) and from 67.9 (67.2, 68.7) to 72.6 (71.9, 73.3), respectively. After adjustments, DM and CVD patients had improvements in the care score of 7.6 and 5.1, respectively, in 2007 compared with 2005 (P < .001).


CONCLUSIONS
Delivery of care recommendations for DM and CVD improved after implementation of a PST. More research is necessary to optimize results and determine whether patient outcomes improve.
Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA. adrianne.c.feldstein@kpchr.org
Adrianne C
AC
Feldstein
Nancy A
NA
Perrin
Robert
R
Unitan
A Gabriela
AG
Rosales
Gregory A
GA
Nichols
David H
DH
Smith
Jennifer
J
Schneider
Carrie M
CM
Davino
Yvonne Y
YY
Zhou
Nancy Louie
NL
Lee
D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics; D016001:Confidence Intervals; D003657:Decision Making; D003661:Decision Support Techniques; D003695:Delivery of Health Care; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000191:economics; D006442:Glycated Hemoglobin; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D009922:Oregon; D010344:Patient Advocacy; D005791:Patient Care / Q000592:standards*; D058007:Physicians, Primary Care / Q000592:standards* / Q000706:statistics & numerical data; D017010:Reminder Systems; D012189:Retrospective Studies; D014861:Washington
D006442:Glycated Hemoglobin