EHRs may improve diabetes management and achievement of treatment goals, particularly among those with worst disease control

Use of a commercially available electronic health record (EHR) was associated with improved care processes and better achievement of intermediate treatment outcomes for outpatients with diabetes, a study found.

To examine the association between the EHR and disease control in diabetics, researchers looked at diabetes management and treatment outcomes sequentially across 17 medical centers from 2004 to 2009, adjusting for variables including patient characteristics, medical center, time trends and facility-level clustering. The staggered start of the EHR across the health system allowed the researchers to compare care before the EHR (control group) and after implementation.

Data were derived from a commercially available, certified EHR in place at Kaiser Permanente Northern California, an integrated delivery system that included nearly 170,000 patients with diabetes.

Results appeared in the Oct. 2 Annals of Internal Medicine.

Use of an EHR was associated with:

• clear improvement in treatment intensification with a trend toward statistical significance at hemoglobin A_1c (HbA_1c) values of 9% or greater (odds ratio [OR], 1.10; 95% CI, 1.05 to 1.15) or low-density lipoprotein (LDL) cholesterol values of 100 to 129 mg/dL (OR, 1.06; 95% CI, 1.00 to 1.12);
• increases in 1-year retesting for HbA_1c and LDL cholesterol levels among all patients, with the most dramatic change among patients with the worst disease control (HbA_1c levels ≥9% or LDL cholesterol levels 130 mg/dL); and
• decreased 90-day retesting among patients with HbA_1c levels less than 7% or LDL cholesterol levels less than 100 mg/dL.

EHR use was also associated with statistically significant reductions in HbA_1c and LDL cholesterol levels, with the largest reductions among patients with the worst control (2.19-mg/dL reduction among patients with baseline LDL cholesterol levels ≥130 mg/dL; P<0.001).

Researchers concluded that use of the EHR was associated with improved drug treatment intensification, monitoring and physiologic control among patients with diabetes, with greater improvements among patients with worse control and less testing in patients already meeting guideline-recommended glycemic and lipid targets.

“Our findings, which are consistent across many steps in the care pathway and are proportional to clinical risk levels, suggest actual improvements in the clinical care of patients with diabetes,” the researchers wrote. “These early effects on linked care processes and patient outcomes also suggest the potential for future downstream improvements in major clinical event rates and health. The lack of any measurable unintended harm in the outcomes for this study is also important because implementation of an EHR could worsen as well as improve care.”