Electronic Health Records Shown to Help Better Control Diabetes

September 7th, 2011 by Ryan Luce No Comments

Written by Michael O'Leary

Randall D. Cebul, M.D.

Professor of Medicine

Director, Better Health
Greater Cleveland

One factor diabetes patients probably don’t think about for achieving better overall outcomes and control of their A1c is whether or not their doctors use an electronic medical record system, but it might be something to think about.

A new study in the New England Journal of Medicine found that 70 percent of diabetes patients whose providers used electronic medical records achieved their A1c targets compared to 48 percent of those whose providers used paper medical charts.

The study led by Dr. Randall Cebul, professor of medicine at Case Western Reserve University, involved 27,206 people in Cuyahoga County, Ohio who made at least two visits to their care providers during a one-year period between July 2009 and June 2010. (Link to published site)

“We compared EHRs with paper-based records in a long-term regional collaborative that seeks to improve care and outcomes for patients with chronic conditions,” the researchers wrote. “EHR sites were associated with higher levels of achievement of and improvement in regionally vetted standards for diabetes care and outcomes.”

The researchers measured quality of care based on whether the providers examined four health factors, A1c, kidney function, eyes, and whether patients were given a flu vaccine. For outcomes, they looked at whether patients achieved recommended standards for A1c, blood pressure, cholesterol, BMI and non-smoking.

Without making adjustments for differences in the patients treated, the researchers found that 50.9 percent of patients at EHR sites met all four standards of care, compared with 6.6 percent of patients at paper-based sites.

For the five outcomes measures they found that 43.7 of the patients in the electronic medical records group achieved all five of their targets compared to 15.7 percent of those treated by doctors using paper charts. In addition to the 70 percent to 48 percent differential for A1c¸ 55.8 percent of patients in the electronic records group achieved their recommended blood pressure, compared to 38.9 percent of those in the paper records goup.

Similarly 87 percent of the electronic records practices met the cholesterol standard compared to 66.1 percent of the paper-based practices. For the BMI standard, 32.8 percent of the electronic practices met the standard compared to 34.1 percent of the paper-based practices.

When the researchers adjusted for differences in insurance coverage, age, sex, race or ethnic group, language preference, estimated household income, and educational level the gap between those treated in practices using electronic records and those using paper records remained but was not quite as big.

The researchers noted that their results contrast with earlier studies showing no difference in care between electronic records patients and paper records, but noted several differences in study design. They said earlier studies used older data and older electronic medical records systems, and included patients who only had one doctor visit or discontinued treatments. Another difference is that all the practices in this study were participating in a regional collaborative, called Better Health Greater Cleveland, which sets specific goals for the quality of care and outcomes for chronic diseases such as diabetes and heart disease.