title: Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.
abstract: BACKGROUND
  Physicians can receive federal payments for meaningful use of complete certified electronic health records (EHRs). Evidence is limited on how EHR use affects clinical care and outcomes.
  
  
  OBJECTIVE
  To examine the association between use of a commercially available certified EHR and clinical care processes and disease control in patients with diabetes.
  
  
  METHODS
  Quasi-experimental design with outpatient EHR implementation sequentially across 17 medical centers. Multivariate analyses adjusted for patient characteristics, medical center, time trends, and facility-level clustering.
  
  
  METHODS
  Kaiser Permanente Northern California, an integrated delivery system.
  
  
  METHODS
  169 711 patients with diabetes mellitus.
  
  
  METHODS
  Use of a commercially available certified EHR.
  
  
  METHODS
  Drug treatment intensification and hemoglobin A(1c) (HbA(1c)) and low-density lipoprotein cholesterol (LDL-C) testing and values.
  
  
  RESULTS
  Use of an EHR was associated with statistically significant improvements in treatment intensification after HbA(1c) values of 9% or greater (odds ratio, 1.10 [95% CI, 1.05 to 1.15]) or LDL-C values of 2.6 to 3.3 mmol/L (100 to 129 mg/dL) (odds ratio, 1.06 [CI, 1.00 to 1.12]); increases in 1-year retesting for HbA(1c) and LDL-C levels among all patients, with the most dramatic change among patients with the worst disease control (HbA(1c) levels ≥9% or LDL-C levels ≥3.4 mmol/L [≥130 mg/dL]); and decreased 90-day retesting among patients with HbA(1c) levels less than 7% or LDL-C levels less than 2.6 mmol/L (<100 mg/dL). The EHR was also associated with statistically significant reductions in HbA(1c) and LDL-C levels, with the largest reductions among patients with the worst control (0.06-mmol/L [2.19-mg/dL] reduction among patients with baseline LDL-C levels ≥3.4 mmol/L [≥130 mg/dL]; P < 0.001).
  
  
  CONCLUSIONS
  The EHR was implemented in a setting with strong baseline performance on cardiovascular care quality measures.
  
  
  CONCLUSIONS
  Use of a commercially available certified EHR was associated with improved drug treatment intensification, monitoring, and physiologic control among patients with diabetes, with greater improvements among patients with worse control and less testing in patients already meeting guideline-recommended glycemic and lipid targets.
  
  
  BACKGROUND
  National Institute of Diabetes and Digestive and Kidney Diseases.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA. mary.e.reed@kp.org
authors.forename: Mary
authors.initials: M
authors.lastname: Reed
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.forename: Ilana
authors.initials: I
authors.lastname: Graetz
authors.forename: Richard
authors.initials: R
authors.lastname: Brand
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.forename: Bruce
authors.initials: B
authors.lastname: Fireman
authors.forename: Marc
authors.initials: M
authors.lastname: Jaffe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D016903:Drug Monitoring; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents