Journal of General Internal Medicine

, Volume 27, Issue 4, pp 420–424 | Cite as

The Association Between Personal Health Record Use and Diabetes Quality Measures

  • Mark Tenforde
  • Amy Nowacki
  • Anil Jain
  • John Hickner
Original Research



Electronic personal health records (PHRs) have the potential to empower patients in self-management of chronic diseases, which should lead to improved outcomes.


To measure the association between use of an advanced electronic medical record-linked PHR and diabetes quality measures in adults with diabetes mellitus (DM).


Retrospective audit of PHR use and multivariable regression analyses.


10,746 adults 18–75-years of age with DM seen at least twice at the office of their primary care physician at the Cleveland Clinic from July 2008 through June 2009.

Main Measures

PHR use was measured as number of use days. Diabetes quality measures were: hemoglobin A1c (HbA1c), LDL cholesterol, blood pressure, body mass index (BMI), HbA1c testing, ACEi/ARB use and/or microalbumin testing, pneumococcal vaccination, foot and dilated eye examination, and smoking status.

Key Results

Compared to non-users, PHR users were younger, had higher incomes and educational attainment, were more likely to identify as Caucasian, and had better unadjusted and adjusted diabetes quality measure profiles. Adjusted odds ratio of HbA1c testing was 2.06 (p < 0.01) and most recent HbA1c was 0.29% lower (p < 0.01). Among PHR users, increasing number of login days was generally not associated with more favorable diabetes quality measure profiles.


PHR use, but not intensity of use, was associated with improved diabetes quality measure profiles. It is likely that better diabetes profiles among PHR users is due to higher level of engagement with their health among those registered for the PHR rather than PHR use itself. PHR use was infrequent. To maximize value, next-generation PHRs must be designed to engage patients in everyday diabetes self-management.


personal health record electronic personal health record PHR chronic disease 


Conflict of Interests

None disclosed.


  1. 1.
    American Diabetes Association. Economic costs of diabetes in the U.S. In 2007. Diabetes Care. 2008;31(3):596–615.CrossRefGoogle Scholar
  2. 2.
    Pagliari C, Detmer D, Singleton P. Potential of electronic personal health records. BMJ. 2007; 335(7615):330-3.Google Scholar
  3. 3.
    Tenforde M, Jain A, Hickner J. The value of personal health records for chronic disease management: what do we know? Fam Med. 2011 May;43(5):351–4.PubMedGoogle Scholar
  4. 4.
    Grant RW, Wald JS, Schnipper JL, et al. Practice-linked online personal health records for type 2 diabetes mellitus: A randomized controlled trial. Arch Intern Med. 2008;168(16):1776–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Holbrook A, Thabane L, Keshavjee K, et al. Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial. CMAJ. 2009;181(1–2):37–44.PubMedGoogle Scholar
  6. 6.
    Ralston JD, Hirsch IB, Hoath J, Mullen M, Cheadle A, Goldberg HI. Web-based collaborative care for type 2 diabetes: A pilot randomized trial. Diabetes Care. 2009;32(2):234–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Goel MS, Brown TL, Williams A, Hasnain-Wynia R, Thompson JA, Baker DW. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med. 2011Google Scholar
  8. 8.
    Yamin CK, Emani S, Williams DH, et al. The digital divide in adoption and use of a personal health record. Arch Intern Med. 2011;171(6):568–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Brennan PF, Downs S, Casper G. Project HealthDesign: Rethinking the power and potential of personal health records. J Biomed Inform. 2010; 43(5): S3-5.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Mark Tenforde
    • 1
  • Amy Nowacki
    • 1
  • Anil Jain
    • 1
  • John Hickner
    • 1
    • 2
    • 3
  1. 1.Cleveland Clinic Lerner College of MedicineCleveland ClinicClevelandUSA
  2. 2.Medicine InstituteCleveland ClinicClevelandUSA
  3. 3.Case Western Reserve University School of MedicineCleveland ClinicClevelandUSA

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