title: Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model.
abstract: The effect of practice facilitation that provides onsite quality improvement (QI) and electronic health record (EHR) coaching on chronic care outcomes is unclear. This study evaluates the effectiveness of such a program-similar to an agricultural extension center model-that provides these services.
  
  
  
  Through the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act, the North Carolina Area Health Education Centers program became the Regional Extension Center for Health Information Technology (REC) for North Carolina. The REC program provides onsite technical assistance to help small primary care practices achieve meaningful use of certified EHRs. While pursuing meaningful use functionality, practices were also offered complementary onsite advice regarding QI issues. We followed the first 50 primary care practices that utilized both EHR and QI advice targeting diabetes care.
  
  
  
  The achievement of meaningful use of certified EHRs and performance of QI with onsite practice facilitation showed an absolute improvement of 19% in the proportion of patients who achieved excellent diabetes control (hemoglobin A1c < 7%) compared to baseline. In addition, the percentages of patients with poorly controlled diabetes (hemoglobin A1c > 9%) fell steeply in these practices.
  
  
  
  No control group was available for comparison.
  
  
  
  Practice facilitation that provided EHR and QI coaching support showed important improvements in diabetes outcomes in practices that achieved meaningful use of their EHR systems. This approach holds promise as a way to help small primary care practices achieve excellent patient outcomes.
authors.affiliation: professor of medicine, Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina samuel_cykert@med.unc.edu.
authors.forename: Samuel
authors.initials: S
authors.lastname: Cykert
authors.affiliation: associate director for quality, North Carolina Area Health Education Centers Program; adjunct professor, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Ann
authors.initials: A
authors.lastname: Lefebvre
authors.affiliation: director emeritus, North Carolina Area Health Education Centers Program; professor of social medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bacon
authors.affiliation: director, North Carolina Area Health Education Centers Program; professor, Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Warren
authors.initials: W
authors.lastname: Newton
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000592:standards; D062527:Meaningful Use / Q000458:organization & administration*; D017146:Models, Organizational; D009657:North Carolina; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D015397:Program Evaluation; D058996:Quality Improvement