Electronic Medical Record Clinical Reminder Use and Quality of Diabetic Care in Primary Care Settings
Shannon Wu
Johns Hopkins Bloomberg School of Public Health
Shannon Wu is a second year doctoral student in Health Services Research and Policy in the Health Policy and Management Department at the Johns Hopkins Bloomberg School of Public Health. Her main areas of research are in health information technology policies and the effects of payment reforms on quality and outcomes of care. Specifically, she hopes to develop a broader research agenda of assessing health information technology needs and capabilities across providers, particularly in the long-term care setting, and examining their effects on quality and outcomes of care. She has previously worked as an analyst in the Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services and as a consultant at IBM. She received her bachelors in psychology from Princeton University.
Abstract
Introduction: Underuse of primary care services in diabetes care is common for adults. Current federal health information technology policies aim to improve quality of care. This study examines the relationship between... [ view full abstract ]
Introduction: Underuse of primary care services in diabetes care is common for adults. Current federal health information technology policies aim to improve quality of care. This study examines the relationship between electronic health record’s (EHR) clinical reminder use and quality of primary care for diabetic patients.
Methods: We analyzed primary care visits from 2010-2013 using data from the National Ambulatory Medical Care Survey (NAMCS), an annual and national probability sample of ambulatory visits made to office-based physicians, to examine the quality of care provided for diabetic adults 18-75 years old. Logistic regressions were used to estimate the association between the routine use of clinical reminders and recommended diabetic services. These procedures, recommended by the American Diabetic Association for primary care, include hemoglobin A1c and lipid panel tests; urinalysis, retinal, foot, and neurological exams; and smoking, diet, exercise and weight counseling for diabetic smokers and overweight individuals. All models controlled for patient and visit characteristics. All estimates used visit-level weights to account for survey design.
Results: An estimated 74,073,736 visits were made by diabetic adults age 18-75 years old to office-based primary care physicians from 2010-2013. Guideline standards were performed infrequently (Table 1). Clinical reminder use was associated with higher odds of providing hemoglobin A1c and urinalysis tests (OR=1.52, p<.01; OR=1.79, p<.05) in visits made by diabetic patients. Clinical reminder use was not associated with providing appropriate counseling services in visits for diabetic smokers or overweight diabetics.
Discussion: Clinical reminder use was found to be associated with higher odds of performing certain recommended services for diabetic patients. These findings support the premise that federal policies encouraging meaningful use of EHRs may improve quality of care. Underuse of diabetes care may be alleviated by use of clinical reminders in primary care.
Authors
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Shannon Wu
(Johns Hopkins Bloomberg School of Public Health)
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Kitty Chan
(Johns Hopkins Bloomberg School of Public Health)
Topic Area
Organizational factors (such as structure and culture) that drive overuse
Session
AS-2A » Abstract Slams: Interventions to Reduce Overuse (13:30 - Friday, 5th May, Salons 1, 2, & 3)
Presentation Files
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