Impact of an EHR-Based Diabetes Management Form on Quality and Outcomes of Diabetes Care in Primary Care Practices

Abstract

Health information technology shows promise for improving chronic disease care. This study assessed the impact of a diabetes management form (DMF), accessible within an electronic health record. From 2007 to 2009, 2108 diabetes patients were seen in 20 primary care practices; 1103 visits involved use of the DMF in 2008. The primary outcome was “optimal care”: HbA1c ≤8%, low-density lipoprotein (LDL) cholesterol <100 mg/dL, blood pressure <130/80 mm Hg, not smoking, and aspirin prescription in patients ≥40 years. After adjusting for number of visits, age, sex, and insulin use, DMF-exposed patients showed less improvement in attaining “optimal care” (estimated difference-in-difference [DID] = −2.06 percentage points; P < .001), LDL cholesterol (DID = −2.30; P = .023), blood pressure (DID = −3.05; P < .001), and total cholesterol (DID = −0.47; P = .004) targets. Documented microalbumin tests, aspirin prescription, and eye and foot exams increased more. Thus, DMF use was associated with smaller gains in achieving evidence-based targets, but greater improvement in documented delivery of care.