Division of General Internal Medicine, New York University School of Medicine, 227 East 30th St., New York, NY 10016, USA.
Am J Manag Care. 2011 Dec;17(12 Spec No.):SP103-10.
To assess the impact of an electronic medical record (EMR) with clinical decision support (CDS) and performance feedback on provider adherence to guideline-recommended care and blood pressure (BP) control compared with a standard EMR alone.
Quasi-experimental with repeated measures.
The study was conducted in a 4-site, federally qualified health center, Open Door Family Medical Centers, located in New York. The research team, Open Door leadership, providers, and staff developed and implemented a tailored multicomponent CDS system, which included a BP alert, a hypertension (HTN) order set, an HTN template, and clinical reminders. We extracted patient-level data for each encounter 17 months prior to implementation of the intervention (June 2007-October 2008) and 15 months post-intervention (April 2009-June 2010), from the EMR's data tables for all adult nonobstetric patients with a diagnosis of HTN (N = 3636).
Rates of HTN control were significantly greater in the post-intervention period compared with the baseline period (50.9% vs 60.8%; P <.001). Process measures, derived from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Guidelines, also improved significantly. Logistic regression with generalized estimating equations showed that patients were 1.5 times more likely to have controlled BP post-intervention than pre-intervention. Correlates of poor BP control were black race, higher body mass index, diabetes, female gender, income, and a greater number of prescribed antihypertensive medications.
Our findings suggest that health information technology that is implemented as part of a multicomponent quality improvement initiative can lead to improvements in HTN care and outcomes.
评估电子病历（EMR）与临床决策支持（CDS）和绩效反馈对提供者遵循指南推荐的治疗和血压（BP）控制的影响，与仅使用标准 EMR 相比。
具有重复测量的准实验。
该研究在纽约的 4 个地点、联邦合格的健康中心 Open Door Family Medical Centers 进行。研究小组、Open Door 领导层、提供者和工作人员开发并实施了量身定制的多组件 CDS 系统，其中包括 BP 警报、高血压（HTN）医嘱集、HTN 模板和临床提醒。我们从 EMR 的数据表中提取了每个就诊的患者水平数据，这些数据来自干预实施前 17 个月（2007 年 6 月至 2008 年 10 月）和干预后 15 个月（2009 年 4 月至 2010 年 6 月）的所有患有 HTN 诊断的成年非产科患者（N=3636）。
与基线期相比，干预后 HTN 控制率显著更高（50.9%比 60.8%；P<.001）。源自第七次联合国家委员会预防、检测、评估和治疗高血压指南的过程指标也显著改善。广义估计方程的逻辑回归显示，干预后患者控制 BP 的可能性是干预前的 1.5 倍。BP 控制不良的相关因素是黑种人、更高的体重指数、糖尿病、女性、收入和更多的降压药物处方。
我们的发现表明，作为多组件质量改进计划的一部分实施的健康信息技术可以改善 HTN 护理和结果。
