Leveraging electronic health records to develop measurements for processes of care.
OBJECTIVE
To assess the reliability of data in electronic health records (EHRs) for measuring processes of care among primary care physicians (PCPs) and examine the relationship between these measures and clinical outcomes.


METHODS
EHR data from 15,370 patients with diabetes, 49,561 with hypertension, in a group practice serving four Northern California counties.


METHODS
Exploratory factor analysis (EFA) and multilevel analyses of the relationships between processes of care variables and factor scales with control of hemoglobin A1c, blood pressure (BP), and low density lipoprotein (LDL) among patients with diabetes and BP among patients with hypertension.


RESULTS
Volume of e-messages, number of days to the third-next-available appointment, and team communication emerged as reliable factors of PCP processes of care in EFA (Cronbach's alpha=0.73, 0.62, and 0.91). Volume of e-messages was associated with higher odds of LDL control (≤100) (OR=1.13, p<.05) among patients with diabetes. Frequent in-person visits were associated with better BP (OR=1.02, p<.01) and LDL control (OR=1.01, p<.01) among patients with diabetes, and better BP control (OR=1.04, p<.01) among patients with hypertension.


CONCLUSIONS
The EHR offers process of care measures which can augment patient-reported measures of patient-centeredness. Two of them are significantly associated with clinical outcomes. Future research should examine their association with additional outcomes.
Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301.
Ming
M
Tai-Seale
Caroline J
CJ
Wilson
Laura
L
Panattoni
Nidhi
N
Kohli
Ashley
A
Stone
Dorothy Y
DY
Hung
Sukyung
S
Chung
D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002140:California; D008078:Cholesterol, LDL; D003142:Communication; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
Primary care; electronic health records; patient-centered care