|
Description
|
Background: Prior research has shown that patients in the US generally receive just over half of the outpatient care recommended by expert guidelines. Electronic health records (EHR) have been proposed as a solution for improving ambulatory health care quality in the US. However, studies on the association of EHR on outpatient quality in US physician practices are conflicted and largely negative. In this study, we examine the effect of overall EHR use, specific EHR capabilities and physician practice characteristics using recent nationally representative outpatient survey data and non-parametric techniques to improve on methods of prior studies. Methods: We used data from the federally administered National Ambulatory Medical Care Survey (NAMCS) across 2005-7. In a observational, cross-sectional analysis, we first examined EHR capability use from 2005-7 and then examined the effect of using any EHR, and having specific EHR capabilities or certain practice characteristics on adherence to eight cardiovascular quality measures cited by the federal government as measurement priorities with modern EHR systems. All analyses were performed using data pre-processed with a matching algorithm to augment the comparison between groups with and without the EHR or practice characteristic examined. Results: Over all three years, electronic health records were used in 23% (Screening/Guideline Reminder Systems) to 49% (Patient Demographics) of pati ent visits, depending on the exact type of EHR being used. When examining the effect of any EHR use on eight quality indicators, no consistent association between quality performance and EHR was observed. When examining specific EHR capabilities, implementation of screening/guideline reminders was associated with an increase in quality performance in measures of beta blocker use in congestive heart failure (CHF) (FD, 13.6; 95% CI, 0.4 to 26.3) and blood pressure control in ischemic vascular disease (IVD) patients (FD, 8.7; 95% CI, 2.4 to 15.7). In addition, use of electronic physician notes were correlated with an improvement in angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker (ACE/ARB) use in coronary artery disease (CAD) patients with diabetes mellitus (DM) (FD, 20.1; 95% CI, 5.8 to 34.6) and in blood pressure control in DM patients (FD, 10.4; 95% CI, 1.0 to 19.8). These effects were balanced by a negative association of electronic prescription order entry and electronic test results on blood pressure management quality measures. Conclusions: Our results suggest positive effects on quality performance of some more advanced EHR components, notably electronic physician notes and electronic screening/guideline reminder systems. However, further research with longitudinal data is necessary to confirm these results. (2010-04-28)
|
