EMRs could be used to help improve diabetes diagnosis, quality of care

Through accurate coding, electronic medical records (EMRs) may help improve diagnosis of diabetes and quality of care, according to a recent study.

Researchers performed a cross-sectional study and retrospective observational cohort analysis of primary care EMRs obtained from a U.S. database and examined whether patients with undiagnosed diabetes could be identified via simple algorithms applied to the EMR data. Quality of care for patients with uncoded and coded diabetes was then compared with quality of care provided to established diabetic patients in England. The study results were published online by CMAJ Open on Nov. 4.

A total of 11,540,454 EMRs from more than 9,000 primary care clinics in the U.S. were included in the study. Overall, 1,110,398 records showed diagnosed diabetes (61.9% based on a diagnostic code indicating diabetes and 38.1% based on medication use), and 10,430,056 showed no diabetes. Among the latter group, at least 2 abnormal fasting or random blood glucose values were noted in 40,359 records (0.4%) and 23,261 records (0.2%) had at least 1 documented HbA1c level of 6.5% or more. Information on quality of care was available for 622,260 patients; those with a coded diagnosis of diabetes received significantly better care than those with uncoded diabetes (P<0.01). U.S. care was generally inferior in quality overall to care in England, however. For example, 59.2% of diabetic patients in the U.S. had an HbA1c result recorded, while 97.2% in England did.

The authors noted that differences in data collection between the U.S. and Europe complicated cross-national comparisons, among other limitations. However, they concluded that applying algorithms to EMRs in primary care identified a significant proportion of U.S. patients with probable undiagnosed diabetes. “Whether fasting blood glucose, random blood glucose or HbA1c values are used, the detection of diabetes is a prerequisite to high-quality care,” they wrote. “Our results suggest a need for heightened recognition and follow-up of these signals in patients not known to have diabetes.” Electronic diabetes registers that capture data on blood glucose levels, HbA1c levels, and quality-of-care data could help to easily and inexpensively identify patients at risk for undetected diabetes and those receiving inferior care, the researchers wrote.