Linder Jeffrey A, Ma Jun, Bates David W, Middleton Blackford, Stafford Randall S
Division of General Medicine, Brigham and Women's Hospital, 1620 Tremont St, BC-3-2X, Boston, MA 02120, USA.
Arch Intern Med. 2007 Jul 9;167(13):1400-5. doi: 10.1001/archinte.167.13.1400.
Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. We assessed the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey.
We performed a retrospective, cross-sectional analysis of visits in the 2003 and 2004 National Ambulatory Medical Care Survey. We examined EHR use throughout the United States and the association of EHR use with 17 ambulatory quality indicators. Performance on quality indicators was defined as the percentage of applicable visits in which patients received recommended care.
Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P = .01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P = .003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P = .01).
As implemented, EHRs were not associated with better quality ambulatory care.
电子健康记录（EHRs）已被提议作为提高医疗质量的可持续解决方案。我们在一项全国代表性调查中评估了实际使用电子健康记录与门诊医疗质量之间的关联。
我们对2003年和2004年全国门诊医疗调查中的就诊情况进行了回顾性横断面分析。我们研究了美国各地电子健康记录的使用情况以及电子健康记录的使用与17项门诊质量指标之间的关联。质量指标的表现定义为患者接受推荐治疗的适用就诊次数的百分比。
在2003年和2004年美国估计的18亿次门诊就诊（95%置信区间[CI]，17亿 - 20亿次）中，18%（95%CI，15% - 22%）的就诊使用了电子健康记录。对于17项质量指标中的14项，使用电子健康记录的就诊与未使用电子健康记录的就诊在表现上没有显著差异。这些指标的类别包括常见疾病的医疗管理、推荐的抗生素处方、预防性咨询、筛查测试以及避免老年患者使用潜在不适当的药物处方。对于2项质量指标，使用电子健康记录的医疗机构的就诊表现明显更好：避免抑郁症患者使用苯二氮䓬类药物（91%对84%；P = 0.01）以及在一般体检中避免常规尿液分析（94%对91%；P = 0.003）。对于1项质量指标，使用电子健康记录的医疗机构的就诊质量明显更差：向高胆固醇血症患者开具他汀类药物（33%对47%；P = 0.01）。
实际使用电子健康记录与更好的门诊医疗质量无关。
