Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Am J Manag Care. 2011 Sep;17(9):626-32.
Adding clinical decision support (CDS) to electronic health records (EHRs) is required under meaningful use legislation, but there has been little national data on effectiveness in improving clinical outcomes. We sought to determine whether EHRs with CDS improved blood pressure control in US primary care visits.
We used a cross-sectional, nationally representative survey.
We examined adult visits to primary care physicians using the 2007 and 2008 National Ambulatory Medical Care Survey (NAMCS).
We found that patients had a mean age of 52 years, 34% were male, 15% had diabetes, and 70% were white. Rates of blood pressure control were significantly higher in visits where both an EHR and CDS (79%) were used, compared with visits where physicians used neither tool (74%; P = .004). Blood pressure control rates remained higher after adjusting for potential confounders. In unadjusted analyses, mean systolic blood pressure was 2 mm Hg lower in visits with the use of both an EHR and CDS, compared with visits where physicians used neither tool (P = .03), and this difference remained significant after adjustment.
The NAMCS shows that physician use of an EHR with CDS is associated with improved blood pressure control. These findings are important because small improvements in blood pressure control are associated with reductions in cardiovascular morbidity and mortality.
根据有意义的使用法规，需要在电子健康记录 (EHR) 中添加临床决策支持 (CDS)，但关于改善临床结果的有效性，全国范围内的数据很少。我们试图确定 EHR 与 CDS 是否可以改善美国初级保健就诊中的血压控制。
我们使用了横断面、全国代表性调查。
我们使用 2007 年和 2008 年国家门诊医疗调查 (NAMCS) 检查了初级保健医生的成人就诊情况。
我们发现，患者的平均年龄为 52 岁，34%为男性，15%患有糖尿病，70%为白人。在同时使用 EHR 和 CDS 的就诊中（79%），血压控制率明显高于既不使用 EHR 也不使用 CDS 的就诊中（74%；P =.004）。调整潜在混杂因素后，血压控制率仍然较高。在未调整分析中，与既不使用 EHR 也不使用 CDS 的就诊相比，同时使用 EHR 和 CDS 的就诊中平均收缩压降低了 2mmHg（P =.03），调整后这一差异仍然显著。
NAMCS 表明，医生使用带 CDS 的 EHR 与改善血压控制相关。这些发现很重要，因为血压控制的微小改善与心血管发病率和死亡率的降低相关。
