Harry B Burke, Dorothy A Becher, Albert Hoang, Ronald W Gimbel
Abstract
A major justification for the clinical adoption of electronic health records (EHRs) was the expectation that it would improve the quality of medical care. No longitudinal study has tested this assumption.
We used hemoglobin A1c, a recognized clinical quality measure directly related to diabetes outcomes, to assess the effect of EHR use on clinical quality.
We performed a five-and-one-half-year multicentre longitudinal retrospective study of the A1c values of 537 type 2 diabetic patients. The same patients had to have been seen on at least three occasions: once approximately six months prior to EHR adoption (before-EHR), once approximately six monthsafter EHR adoption (after-EHR) and once approximately five years after EHR adoption (five-years), for a total of 1,611 notes.
The overall mean confidence interval (CI) A1c values for the before- EHR, after-EHR and five-years were 7.07 (6.91 - 7.23), 7.33 (7.14 - 7.52) and 7.19 (7.06 - 7.32), respectively. There was a small but significant increase in A1c values between before-EHR and after-EHR, p = .04; there were no other significant differences. There was a significant decrease in notes missing at least one A1c value, from 42% before-EHR to 16% five-years (p < .001).
We found that based on patient's A1c values, EHRs did not improve the clinical quality of diabetic care in six months and five years after EHR adoption. To our knowledge, this is the first longitudinal study to directly assess the relationshipbetween the use of an EHR and clinical quality.
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 28 June 2016.
All research outputs
#22,805,112
of 25,425,223 outputs
Outputs from BMJ Health & Care Informatics
#1
of 1 outputs
Outputs of similar age
#271,123
of 313,975 outputs
Outputs of similar age from BMJ Health & Care Informatics
#1
of 1 outputs
Altmetric has tracked 25,425,223 research outputs across all sources so far. This one is in the 1st percentile – i.e., 1% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1 research outputs from this source. They receive a mean Attention Score of 0.0. This one scored the same or higher as 0 of them.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 313,975 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them
