title: Mixed Influence of Electronic Health Record Implementation on Diabetes Order Patterns for Michigan Medicaid Adults.
abstract: BACKGROUND
  These 2011-2013 analyses examined the authors' hypothesis that relative diabetes care order changes would be measured after electronic health record (EHR) implementation for 291 Medicaid adults who received all of their office-based care at one midwestern federally qualified health center (FQHC) over a 24-month period (n = 2727 encounters, 2489 claims).
  
  
  METHODS
  Beneficiary sociodemographic, clinical, and claims data were validated with clinic EHR and state Medicaid claims linked to providers' national identifier numbers. Overall pre-post order rate comparisons, and a series of controlled within group binary logistic models were conducted under penalized maximum likelihood estimation terms.
  
  
  RESULTS
  After EHR implementation, both the overall order rates and odds ratios of per beneficiary hemoglobin A1C (HbA1C) orders increased significantly (ie, from mean of 0.65 [SD = 1.19] annual tests to 0.96 tests [SD = 1.24] [P < .001]). Although the overall post-EHR order rates of dilated eye exams and microalbumin urine tests appeared fairly stable, the odds of eye exam orders being placed at the claims level decreased significantly (OR = 0.774, P = .0030).
  
  
  CONCLUSIONS
  These mixed results provide evidence of the varied diabetes care ordering patterns likely seen from increased office use of EHR technologies. The authors attempt to explain these post-EHR differences (or lack of) that generally resemble some of the authors' results from another funded project. Ideally, these findings provide Medicaid and health care officials with a more realistic indication of how EHRs may, or may not, influence diabetes care ordering patterns for vulnerable lower-income primary health care consumers.
authors: Statewide Campus System, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA corser@msu.edu.
authors: William
authors: W
authors: Corser
authors: Institute for Health Policy, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
authors: Sha
authors: S
authors: Yuan
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis; D003920:Diabetes Mellitus; D003941:Diagnostic Techniques, Ophthalmological / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008484:Medicaid; D008824:Michigan; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: diabetes primary care; electronic health records; electronic medical records; office-based orders