title: The impact of electronic health records and teamwork on diabetes care quality.
abstract: OBJECTIVE
  Evidence of the impact electronic health records (EHRs) have on clinical outcomes remains mixed. The impact of EHRs likely depends on the organizational context in which they are used. This study focuses on one aspect of the organizational context: cohesion of primary care teams. We examined whether team cohesion among primary care team members changed the association between EHR use and changes in clinical outcomes for patients with diabetes.
  
  
  METHODS
  Retrospective longitudinal study.
  
  
  METHODS
  We combined provider-reported primary care team cohesion with lab values for patients with diabetes collected during the staggered EHR implementation (2005-2009). We used multivariate regression models with patient-level fixed effects to assess whether team cohesion levels changed the association between outpatient EHR use and clinical outcomes for patients with diabetes. Subjects were comprised of 80,611 patients with diabetes, in whom we measured changes in glycated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C).
  
  
  RESULTS
  For A1C, EHR use was associated with an average decrease of 0.11% for patients with higher-cohesion primary care teams compared with a decrease of 0.08% for patients with lower-cohesion teams (difference = 0.02% in A1C; 95% CI, 0.01%-0.03%). For LDL-C, EHR use was associated with a decrease of 2.15 mg/dL for patients with higher-cohesion primary care teams compared with a decrease of 1.42 mg/dL for patients with lower-cohesion teams (difference = 0.73 mg/dL; 95% CI, 0.41-1.11 mg/dL).
  
  
  CONCLUSIONS
  Patients cared for by higher cohesion primary care teams experienced modest but statistically significantly greater EHR-related health outcome improvements, compared with patients cared for by providers practicing in lower cohesion teams.
authors.affiliation: University of Tennessee Health Science Center, 66 N Pauline St, Ste 633, Memphis, TN 38163. E-mail: igraetz@uthsc.edu.
authors.forename: Ilana
authors.initials: I
authors.lastname: Graetz
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.forename: Richard
authors.initials: R
authors.lastname: Brand
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Rundall
authors.forename: Jim
authors.initials: J
authors.lastname: Bellows
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.forename: Marc
authors.initials: M
authors.lastname: Jaffe
authors.forename: Mary E
authors.initials: ME
authors.lastname: Reed
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood* / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D012189:Retrospective Studies
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human