Pollard Cecil, Bailey Kelly A, Petitte Trisha, Baus Adam, Swim Mary, Hendryx Michael
Office of Health Services Research, West Virginia University, Morgantown, W VA 26506-9190, USA.
J Rural Health. 2009 Winter;25(1):77-84. doi: 10.1111/j.1748-0361.2009.00202.x.
Diabetes care is challenging in rural areas. Research has shown that the utilization of electronic patient registries improves care; however, improvements generally have been described in combination with other ongoing interventions. The level of basic registry utilization sufficient for positive change is unknown.
The goal of the current study was to examine differential effects of basic registry utilization on diabetes care processes and clinical outcomes according to level of registry use in a rural setting.
Patients with diabetes (N = 661) from 6 Federally Qualified Health Centers in rural West Virginia were entered into an electronic patient registry. Data from pre- and post-registry were compared among 3 treatment and control groups that had different levels of registry utilization: low, medium, or high (for example, variations in the use of registry-generated progress notes examined at the point-of-care and in the accuracy of registry-generated summary reports to track patients' care). Data included care processes (annual exams, screens to promote wellness, education, and self-management goal-setting) and clinical outcomes (HbA1c, LDL, HDL, cholesterol, triglycerides, blood pressure).
The registry assisted in significantly improving 12 of 13 care processes and 3 of 6 clinical outcomes (HbA1c, LDL, cholesterol) for patients exposed to at least medium levels of registry utilization, but not for the controls. For example, the percent of patients who had received an annual eye exam at follow-up was 11%, 34%, and 38% for the low, medium, and high utilization groups, respectively; only the latter groups improved.
As an initial step to achieving control of diabetes, basic registry utilization may be sufficient to drive improvements in provider-patient care processes and in patient outcomes in rural clinics with few resources.
农村地区的糖尿病护理具有挑战性。研究表明，使用电子患者登记系统可改善护理；然而，改善情况通常是与其他正在进行的干预措施相结合进行描述的。足以带来积极变化的基本登记系统利用率水平尚不清楚。
本研究的目的是根据农村地区登记系统的使用水平，研究基本登记系统利用率对糖尿病护理流程和临床结果的不同影响。
来自西弗吉尼亚州农村地区6家联邦合格健康中心的661名糖尿病患者被纳入电子患者登记系统。在3个登记系统利用率不同的治疗组和对照组（低、中、高，例如，在护理点检查登记系统生成的进展记录的使用差异以及登记系统生成的总结报告跟踪患者护理的准确性差异）之间比较登记前后的数据。数据包括护理流程（年度检查、促进健康的筛查、教育和自我管理目标设定）和临床结果（糖化血红蛋白、低密度脂蛋白、高密度脂蛋白、胆固醇、甘油三酯、血压）。
对于至少中等登记系统利用率的患者，登记系统显著改善了13项护理流程中的12项以及6项临床结果中的3项（糖化血红蛋白、低密度脂蛋白、胆固醇），但对照组未改善。例如，随访时接受年度眼科检查的患者百分比在低、中、高利用率组中分别为11%、34%和38%；只有后两组有所改善。
作为实现糖尿病控制的第一步，基本登记系统利用率可能足以推动资源匮乏的农村诊所改善医患护理流程和患者结局。
