Kaushal R, Edwards A, Kern L M
Department of Healthcare Policy and Research, Weill Cornell Medical College , New York, NY ; Health Information Technology Evaluation Collaborative , New York, NY ; Center for Healthcare Informatics and Policy, Weill Cornell Medical College , New York, NY ; Department of Pediatrics, Weill Cornell Medical College , New York, NY ; Department of Medicine, Weill Cornell Medical College , New York, NY ; New York-Presbyterian Hospital, New York, NY.
Department of Healthcare Policy and Research, Weill Cornell Medical College , New York, NY ; Health Information Technology Evaluation Collaborative , New York, NY ; Center for Healthcare Informatics and Policy, Weill Cornell Medical College , New York, NY.
Appl Clin Inform. 2015 Jan 28;6(1):42-55. doi: 10.4338/ACI-2014-10-RA-0089. eCollection 2015.
The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited.
To determine any association between EHRs and health care utilization.
We conducted a cohort study (2008-2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics.
Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions.
Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs.
联邦政府正在投入约200亿美元用于电子健康记录（EHR），部分目的是应对不断攀升的医疗成本。然而，关于医疗服务提供者使用电子健康记录可降低医疗成本的实证证据有限。
确定电子健康记录与医疗服务利用之间的关联。
我们在纽约州一个多支付方、多提供者的社区哈德逊河谷进行了一项队列研究（2008 - 2009年）。我们纳入了328名主要在小型诊所工作的初级保健医生（诊所规模中位数为4名初级保健医生），他们负责照顾223,772名患者。来自独立执业协会的数据用于确定电子健康记录的采用情况。汇总五个商业健康计划的索赔数据用于描述七种医疗服务利用类型：初级保健就诊、专科就诊、放射检查、实验室检查、急诊就诊、住院和再入院。我们使用负二项回归来确定电子健康记录采用与每种利用结果之间的关联，并对十个医生特征进行了调整。
大约一半（48%）的医生使用纸质记录，另一半（52%）使用电子健康记录。使用电子健康记录的医生每诊治100名患者，专科就诊减少14次（校正p < 0.01），放射检查减少9次（校正p = 0.01）。在初级保健就诊、实验室检查、急诊就诊、住院或再入院率方面没有显著差异。
与未使用电子健康记录的初级保健提供者的患者相比，使用电子健康记录的初级保健提供者的患者进行专科就诊和放射检查的可能性较小。
