Employing the Electronic Health Record to Improve Diabetes Care: A Multifaceted Intervention in an Integrated Delivery System
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Type 2 diabetes is one of the nation’s most prevalent chronic diseases. Although well-known practice guidelines exist, real-life clinical performance often falls short of benchmarks.
Employ an electronic registry derived from a fully integrated electronic health record (EHR) as the cornerstone of an intervention to improve compliance with recommended diabetes performance measures in an integrated practice network.
Geisinger Health System’s network of 38 practice sites providing care to over 20,000 persons with diabetes located in a 40-county region of central and northeastern Pennsylvania.
A multidisciplinary group of physicians worked to create a “bundle” of best practice measures for diabetes. This measurement tool was then used as part of a multifaceted intervention to improve physician performance in diabetes care, including audit and feedback, computerized reminders, and financial incentives. Changes in performance of individual measures and the total “bundle” were tracked monthly over 1 year.
Significant increases were seen in all measures of diabetes care over the 12-month period of the study. Vaccination for pneumococcal disease and influenza improved from 56.5% to 80.8% (p < .0001) and 55.1% to 71.0% (p < .0001), respectively. The percentage of patients with ideal glucose control (HBA1c < 7.0) increased from 32.2% to 34.8% (p < .001), and blood pressure control (<130/80) improved from 39.7% to 43.9% (p < .0001). The overall number of patients receiving all 9 “bundled” measurements improved from 2.4% to 6.5% (p < .0001).
Diabetes care improved significantly in response to a multifaceted intervention featuring the use of an EHR-derived registry in an integrated delivery system. More work is needed to demonstrate that such improvements will translate into improved patient health outcomes.
- Standards of medical care in diabetes—2007. Diabetes Care 30: pp. S4-S41 CrossRef
- Burcack, RC (1989) Barriers to clinical preventive medicine. Prim Care 16: pp. 245-250
- Yarnall, KSH, Pollack, KI, Ostbye, T, Krause, KM, Michener, JL (2003) Primary care: is there enough time for prevention?. Am J Public Health 93: pp. 635-641 CrossRef
- Mandelblatt, J, Kanetsky, PA (1995) Effectiveness of interventions to enhance physician screening for breast cancer. J Fam Pract 40: pp. 162-167
- Gill, JM, Ewen, E, Nsereko, M (2001) Impact of an electronic medical record on quality of care in a primary care office. Del Med J 73: pp. 187-194
- Standards of medical care in diabetes. Diabetes Care 28: pp. S4-S36 CrossRef
- Nolan, T, Berwick, D (2006) All-or-none measurement raises the bar on performance. JAMA 295: pp. 1168-1170 CrossRef
- Agency for Healthcare Research and Quality. 2004 National Healthcare Quality Report. Washington, DC: US Department of Health and Human Series; 2004. AHRQ Publication 05-0013.
- Amundsen G, Werhle D. HealthPartners: 2005–6 Clinical Indicators Report. http://www.healthpartners.com/files/34613.pdf. Accessed April 20, 2007.
- Minnesota Community Measurement 2006 Healthcare Quality Report. April 2007. http://www.mnhealthcare.org/Report/. Accessed April 19, 2007.
- Solomon, DH, Hashimoto, H, Daltroy, L, Liang, MH (1998) Techniques to improve physicians’ uses of diagnostic tests: a new conceptual framework. JAMA 280: pp. 2020-2027 CrossRef
- Durso, SC (2006) Using clinical guidelines designed for older adults with diabetes mellitus and complex health status. JAMA 295: pp. 1935-1940 CrossRef
- Employing the Electronic Health Record to Improve Diabetes Care: A Multifaceted Intervention in an Integrated Delivery System
Journal of General Internal Medicine
Volume 23, Issue 4 , pp 379-382
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- electronic health record
- diabetes care
- multifaceted intervention
- integrated delivery system
- Industry Sectors
- Author Affiliations
- 1. Department of General Internal Medicine, Geisinger Health System, Danville, PA, USA
- 3. Center for Health Research, Geisinger Health System, Danville, PA, USA
- 4. Geisinger Medical Center, Danville, PA, USA
- 2. Division of Community Practice, Geisinger Health System, Danville, PA, USA