Orzano A John, Strickland Pamela Ohman, Tallia Alfred F, Hudson Shawna, Balasubramanian Bijal, Nutting Paul A, Crabtree Benjamin F
Department of Family Medicine/Research Division, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Somerset, NJ 08873, USA.
J Am Board Fam Med. 2007 May-Jun;20(3):245-51. doi: 10.3122/jabfm.2007.03.060185.
Diabetes care requires management of complex clinical information. We examine the relationship between diabetic outcomes and practices' use of information.
We performed a cross-sectional, secondary analysis of baseline data from 50 community primary care practices participating in a practice improvement project. Medical record review assessed clinical targets for diabetes (HbA(1c) < or =8, LDL < or =100, BP < or =130/85). Practices' use of information was derived from clinician responses to a survey on their use of clinical information systems for patient identification and tracking. Hierarchical linear modeling examined relationships between patient outcomes and practice use of information, controlling for patient level covariates (age, gender, hypertension, and cardiovascular comorbidities) and practice level covariates (solo/group, and electronic health record [EHR] presence).
Practices' use of identification and tracking systems significantly (P < .007 and 0.002) increased odds of achieving diabetes care targets (odds ratio [OR] 1.23 95%, confidence interval [CI] 1.06 to 1.44, and OR 1.32 95% CI 1.11 to 1.59). For diabetic patients with hypertension, odds of hypertension control were higher with higher use of tracking systems (OR = 1.52, P = .0017) and reflected similar trend with higher use of identification systems (OR = 1.28, P = .1349). EHR presence was not associated with attainment of clinical targets.
Use of relatively simple systems to identify and track patient information can improve diabetic care outcomes. Practices making investments in an EHR must recognize that this technology alone is not sufficient for achieving desirable clinical outcomes. Researchers must explore the interrelationships of organizational factors necessary for successful information use.
糖尿病护理需要管理复杂的临床信息。我们研究糖尿病治疗结果与医疗机构信息使用情况之间的关系。
我们对参与一项医疗机构改进项目的50家社区初级医疗诊所的基线数据进行了横断面二次分析。病历审查评估了糖尿病的临床指标（糖化血红蛋白[HbA(1c)]≤8，低密度脂蛋白≤100，血压≤130/85）。医疗机构的信息使用情况来自临床医生对关于其使用临床信息系统进行患者识别和跟踪的调查的答复。分层线性模型研究了患者治疗结果与医疗机构信息使用情况之间的关系，同时控制患者层面的协变量（年龄、性别、高血压和心血管合并症）以及医疗机构层面的协变量（单人/团体执业，以及是否存在电子健康记录[EHR]）。
医疗机构对识别和跟踪系统的使用显著（P<.007和0.002）增加了实现糖尿病护理指标的几率（优势比[OR]为1.23，95%置信区间[CI]为1.06至1.44，以及OR为1.32，95%CI为1.11至1.59）。对于患有高血压的糖尿病患者，跟踪系统使用频率越高，高血压得到控制（OR = 1.52，P =.0017）的几率越高，识别系统使用频率越高也呈现类似趋势（OR = 1.28，P =.1349）。电子健康记录的存在与临床指标的达成无关。
使用相对简单的系统来识别和跟踪患者信息可以改善糖尿病护理结果。投资电子健康记录的医疗机构必须认识到，仅这项技术不足以实现理想的临床结果。研究人员必须探索成功使用信息所需的组织因素之间的相互关系。
