title: Sustained improvement in clinical preventive service delivery among independent primary care practices after implementing electronic health record systems.
abstract: BACKGROUND
  Studies showing sustained improvements in the delivery of clinical preventive services are limited. Fewer studies demonstrate sustained improvements among independent practices that are not affiliated with hospitals or integrated health systems. This study examines the continued improvement in clinical quality measures for a group of independent primary care practices using electronic health records (EHRs) and receiving technical support from a local public health agency.
  
  
  METHODS
  We analyzed clinical quality measure performance data from a cohort of primary care practices that implemented an EHR at least 3 months before October 2009, the study baseline. We assessed trends for 4 key quality measures: antithrombotic therapy, blood pressure control, smoking cessation intervention, and hemoglobin A1c (HbA1c) testing based on monthly summary data transmitted by the practices.
  
  
  RESULTS
  Of the 151 practices, 140 were small practices and 11 were community health centers; average time using an EHR was 13.7 months at baseline. From October 2009 through October 2011, average rates increased for antithrombotic therapy (from 58.4% to 74.8%), blood pressure control (from 55.3% to 64.1%), HbA1c testing (from 46.4% to 57.7%), and smoking cessation intervention (from 29.3% to 46.2%). All improvements were significant.
  
  
  CONCLUSIONS
  During 2 years, practices showed significant improvement in the delivery of several key clinical preventive services after implementing EHRs and receiving support services from a public health agency.
authors.affiliation: New York City Department of Health and Mental Hygiene, Primary Care Information Project, 42-09 28th St, 12th Fl, Queens, NY 11101, USA. jwang5@health.nyc.gov
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Wang
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Sebek
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCullough
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Amirfar
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Parsons
authors.forename: Jesse
authors.initials: J
authors.lastname: Singer
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Shih
mesh_terms: D015331:Cohort Studies; D003695:Delivery of Health Care / Q000592:standards*; D003920:Diabetes Mellitus / Q000097:blood; D057286:Electronic Health Records; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000628:therapy; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D016540:Smoking Cessation / Q000706:statistics & numerical data
chemical_list: D005343:Fibrinolytic Agents; D006442:Glycated Hemoglobin
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