Primary Care Information Project, New York City Department of Health and Mental Hygiene, 42-09 28th Street,Queens, NY 11101-4132, USA.
Am J Prev Med. 2011 Dec;41(6):603-9. doi: 10.1016/j.amepre.2011.07.024.
Despite strong evidence that clinical preventive services (CPS) reduce morbidity and mortality, CPS performance has not improved in adult primary care. In addition to implementing electronic health records (EHRs), key factors for improving CPS include providing actionable information at the point of care, technical support staff, and quality-improvement assistance. These resources are not typically available in small practices.
Estimate the impact on CPS delivery after a software upgrade to embed a clinical decision support system and practice-level quality-improvement support services.
Practices were recruited from the Primary Care Information Project, a citywide initiative assisting practices adopt health information technology. Data were collected in 2009 and 2010, and analyses were conducted in 2010 and 2011. Across two time periods, receipt of CPS was calculated for 56 practices. Period 1 measured CPS delivery 2-37 months following implementation of an EHR. Period 2 measured CPS delivery within the first 6 months after an EHR software upgrade.
Substantial increases in the delivery of selected CPS were observed after the EHR software upgrades. Blood pressure control for patients with hypertension increased from 46.0% to 54.8%. Breast cancer screening, recorded BMI, and HbA1c testing for patients with diabetes also increased. More than half of the practices increased their patients' blood pressure control, recorded BMI, breast cancer screening, and HbA1c screening by ≥5 percentage points.
Delivery of CPS can increase in small primary care practices that implement an EHR that includes comprehensive quality-improvement support.
尽管有强有力的证据表明临床预防服务（CPS）可以降低发病率和死亡率，但成人初级保健中的 CPS 性能并未得到改善。除了实施电子健康记录（EHR）外，改善 CPS 的关键因素还包括在护理点提供可操作的信息、技术支持人员和质量改进援助。这些资源在小型实践中通常不可用。
估计在嵌入临床决策支持系统和实践层面质量改进支持服务的软件升级后对 CPS 交付的影响。
实践是从初级保健信息项目中招募的，该项目是全市范围内的一项倡议，旨在帮助实践采用健康信息技术。数据于 2009 年和 2010 年收集，并于 2010 年和 2011 年进行分析。在两个时间段内，为 56 个实践计算了 CPS 的接收情况。第 1 期衡量了在实施电子病历后 2-37 个月内的 CPS 交付情况。第 2 期衡量了在电子病历软件升级后的头 6 个月内的 CPS 交付情况。
在 EHR 软件升级后，观察到选定 CPS 的交付量大幅增加。高血压患者的血压控制从 46.0%增加到 54.8%。记录的 BMI 和 HbA1c 测试也增加了乳腺癌筛查和糖尿病患者。超过一半的实践将其患者的血压控制、记录的 BMI、乳腺癌筛查和 HbA1c 筛查提高了≥5 个百分点。
在实施包括全面质量改进支持的 EHR 的小型初级保健实践中，可以增加 CPS 的交付。
