Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Department of Business and Economics, University of Southern Denmark, Odense, Denmark.
JAMA Netw Open. 2020 May 1;3(5):e206603. doi: 10.1001/jamanetworkopen.2020.6603.
Electronic health record (EHR) systems and disease management programs (DMP) are often promoted, but associated health care cost changes are not well understood.
To evaluate the association between annual health care costs of patients with type 2 diabetes and the use of an electronic health record system with a disease management program (EHR/DMP) in general practice.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined patients with type 2 diabetes in Denmark between January 1, 2008, and December 31, 2014, who attended practices that either used an EHR/DMP at a high level or never used the disease management system. An EHR/DMP system was rolled out across general practices in Denmark beginning in 2011 and was discontinued in 2014. Data were analyzed between March 2019 and March 2020.
The main outcome was total health care costs, and the secondary outcomes were primary care, medication, nonhospital specialist, and hospital (total, outpatient, inpatient, and emergency) costs. Regression models were used to estimate EHR/DMP-associated percentage differences in patients' annual health care treatment costs across health care treatment categories. All models included general practice-level fixed effects and patient-level controls. Two-part models examined robustness of estimated associations for hospital cost categories.
Of 33 970 patients included in the analysis, 15 953 (8016 [50.2%] male; mean [SD] age, 59.9 [13.3] years) attended 244 general practices that used the system at a high level, and 18 017 (9291 [51.6%] male; mean [SD] age, 60.0 [12.9] years) attended 344 general practices that had never used the system. Use of the EHR/DMP was associated with 3.2% higher (95% CI, 0.9%-5.6%) annual general practice treatment costs and with 6.4% lower (95% CI, -11.6% to -1.2%) annual hospital emergency visit costs. The associations between EHR/DMP use and annual total hospital (percentage difference, -0.8%; 95% CI, -7.5% to 5.7%) and total health care (percentage difference, -0.1%; 95% CI, -2.1% to 1.9%) cost changes were not statistically significant.
Among patients with type 2 diabetes, attendance at general practices that used an EHR/DMP was associated with a moderate increase in primary care costs and a reduction in emergency hospital visit costs but no significant change in total health care costs. Large health care cost savings associated with improved use of EHR-based disease management systems should not be expected to be realized in the short term.
重要性：电子健康记录（EHR）系统和疾病管理程序（DMP）通常被推广，但与之相关的医疗成本变化尚不清楚。
目的：评估 2 型糖尿病患者的年度医疗费用与在普通实践中使用具有疾病管理程序（EHR/DMP）的电子健康记录系统之间的关联。
设计、地点和参与者：本回顾性队列研究检查了 2008 年 1 月 1 日至 2014 年 12 月 31 日期间丹麦的 2 型糖尿病患者，他们在使用高水平 EHR/DMP 或从未使用过疾病管理系统的实践中就诊。丹麦的普通实践从 2011 年开始推出 EHR/DMP 系统，并于 2014 年停止使用。数据于 2019 年 3 月至 2020 年 3 月之间进行分析。
主要结果和措施：主要结果是总医疗费用，次要结果是初级保健、药物、非医院专科医生和医院（总、门诊、住院和急诊）费用。回归模型用于估计 EHR/DMP 相关的患者年度医疗治疗费用在各个医疗治疗类别中的百分比差异。所有模型都包括普通实践层面的固定效应和患者层面的控制。两部分模型检验了医院成本类别中估计关联的稳健性。
结果：在纳入分析的 33970 名患者中，15953 名（8016 名[50.2%]男性；平均[标准差]年龄，59.9[13.3]岁）在 244 家使用该系统的普通实践就诊，18017 名（9291 名[51.6%]男性；平均[标准差]年龄，60.0[12.9]岁）在 344 家从未使用过该系统的普通实践就诊。使用 EHR/DMP 与每年高出 3.2%（95%CI，0.9%-5.6%）的普通医疗治疗费用和每年低 6.4%（95%CI，-11.6%至-1.2%）的急诊医院就诊费用相关。EHR/DMP 使用与每年总医院（百分比差异，-0.8%；95%CI，-7.5%至 5.7%）和总医疗保健（百分比差异，-0.1%；95%CI，-2.1%至 1.9%）成本变化之间的关联无统计学意义。
结论和相关性：在 2 型糖尿病患者中，在使用 EHR/DMP 的普通实践就诊与初级保健费用适度增加和急诊医院就诊费用减少相关，但总医疗保健费用没有显著变化。不应期望在短期内实现与 EHR 为基础的疾病管理系统的改进使用相关的大幅医疗成本节约。
