title: Impact of an EHR-based diabetes management form on quality and outcomes of diabetes care in primary care practices.
abstract: Health information technology shows promise for improving chronic disease care. This study assessed the impact of a diabetes management form (DMF), accessible within an electronic health record. From 2007 to 2009, 2108 diabetes patients were seen in 20 primary care practices; 1103 visits involved use of the DMF in 2008. The primary outcome was "optimal care": HbA1c ≤8%, low-density lipoprotein (LDL) cholesterol <100 mg/dL, blood pressure <130/80 mm Hg, not smoking, and aspirin prescription in patients ≥40 years. After adjusting for number of visits, age, sex, and insulin use, DMF-exposed patients showed less improvement in attaining "optimal care" (estimated difference-in-difference [DID] = -2.06 percentage points; P < .001), LDL cholesterol (DID = -2.30; P = .023), blood pressure (DID = -3.05; P < .001), and total cholesterol (DID = -0.47; P = .004) targets. Documented microalbumin tests, aspirin prescription, and eye and foot exams increased more. Thus, DMF use was associated with smaller gains in achieving evidence-based targets, but greater improvement in documented delivery of care.
authors.affiliation: Health Research & Educational Trust, Chicago, IL Yale University, New Haven, CT.
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX.
authors.forename: Briget
authors.initials: B
authors.lastname: da Graca
authors.affiliation: HealthTexas Provider Network, Baylor Health Care System, Dallas, TX.
authors.forename: Phil
authors.initials: P
authors.lastname: Aponte
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX.
authors.forename: H Greg
authors.initials: HG
authors.lastname: Stanek
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX.
authors.forename: Terianne
authors.initials: T
authors.lastname: Cowling
authors.affiliation: HealthTexas Provider Network, Baylor Health Care System, Dallas, TX.
authors.forename: Cliff
authors.initials: C
authors.lastname: Fullerton
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Hollander
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX dj.ballard@baylorhealth.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D057286:Electronic Health Records / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care; D016540:Smoking Cessation; D014787:Vision Tests
chemical_list: D001241:Aspirin; D002784:Cholesterol; D006442:Glycated Hemoglobin
keywords: diabetes; electronic health records