Clinical informatics to improve quality of care: a population-based system for patients with diabetes mellitus.

BACKGROUND The prevalence of diabetes mellitus is increasing in the USA. However, control of intermediate outcome measures remains substandard. Recently, significant emphasis has been placed on the value of electronic medical records and informatics systems to improve the delivery of health care. OBJECTIVE To determine whether a clinical informatics system improves care of patients with diabetes mellitus. METHODS In this quality improvement pilot initiative, we identified 48 patients with diabetes mellitus who were due for their annual haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and microalbumin tests. Through our newly developed clinical informatics initiative, patients were reminded to schedule tests and a physician appointment. Seventy-five patients without reminders served as controls. RESULTS A significant improvement in LDL control was achieved in the intervention group (35.4% vs 13.3%; P=0.004). The intervention group had a greater percentage of patients who underwent the three tests, and members of this group also showed greater control of haemoglobin A1c, but these differences were not statistically significant. CONCLUSIONS A clinical informatics system, used to deliver proactive, co-ordinated care to a population of patients with diabetes mellitus, can improve process and also quality outcome measures. Larger studies are needed to confirm these early findings.

[1]  E. McGlynn,et al.  Profiling the quality of care in twelve communities: results from the CQI study. , 2004, Health affairs.

[2]  Carl van Walraven,et al.  Clinical inertia in response to inadequate glycemic control: do specialists differ from primary care physicians? , 2005, Diabetes care.

[3]  E. Balas,et al.  Computerized Knowledge Management in Diabetes Care , 2004, Medical care.

[4]  Simon de Lusignan,et al.  Achieving benefit for patients in primary care informatics: the report of a international consensus workshop at Medinfo 2007. , 2007, Informatics in primary care.

[5]  Stephen W. Sorensen,et al.  Lifetime risk for diabetes mellitus in the United States. , 2003, JAMA.

[6]  T. Bodenheimer.  The future of primary care: transforming practice. , 2008, The New England journal of medicine.

[7]  Thomas Bodenheimer,et al.  Clinical Crossroads a 63-year-old Man with Multiple Cardiovascular Risk Factors and Poor Adherence to Treatment Plans , 2022 .

[8]  Rajeev Chaudhry,et al.  Web-based proactive system to improve breast cancer screening: a randomized controlled trial. , 2007, Archives of internal medicine.

[9]  Richard W Grant,et al.  Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. , 2005, Diabetes care.

[10]  E H Wagner,et al.  Effect of improved glycemic control on health care costs and utilization. , 2001, JAMA.

[11]  Standards of Medical Care for Patients With Diabetes Mellitus , 1998, Diabetes Care.

[12]  Plamen Nikolov,et al.  Economic Costs of Diabetes in the U.S. in 2002 , 2003, Diabetes care.

[13]  H. Chueh,et al.  Clinical inertia in the management of Type 2 diabetes metabolic risk factors , 2004, Diabetic medicine : a journal of the British Diabetic Association.

[14]  L. Becker,et al.  Nurse-mediated cholesterol management compared with enhanced primary care in siblings of individuals with premature coronary disease. , 1998, Archives of internal medicine.

[15]  William Branch,et al.  Clinical Inertia , 2001, Annals of Internal Medicine.

[16]  D. Ballard,et al.  The Improving Primary Care of African Americans with Diabetes (IPCAAD) project: rationale and design. , 2002, Controlled clinical trials.

[17]  D. Bates,et al.  Comprehensive computerised primary care records are an essential component of any national health information strategy: report from an international consensus conference. , 2004, Informatics in primary care.

[18]  M. D. David Blumenthal.  The Federal Role in Promoting Health Information Technology , 2009 .

[19]  Paul Kolm,et al.  An intervention to overcome clinical inertia and improve diabetes mellitus control in a primary care setting: Improving Primary Care of African Americans with Diabetes (IPCAAD) 8. , 2006, Archives of internal medicine.

[20]  L. Phillips,et al.  Diabetes in urban African-Americans. XV. Identification of barriers to provider adherence to management protocols. , 1999, Diabetes care.

[21]  E. McGlynn,et al.  The quality of health care delivered to adults in the United States. , 2003, The New England journal of medicine.

[22]  MEASURING PROGRESS , 2007 .

[23]  M. Engelgau,et al.  Population-based estimates of mortality associated with diabetes: use of a death certificate check box in North Dakota. , 2001, American journal of public health.

[24]  B. Starfield,et al.  Contribution of primary care to health systems and health. , 2005, The Milbank quarterly.

[25]  B. B. Fleming,et al.  Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels. , 2000, JAMA.

[26]  Esther B Neuwirth,et al.  Understanding panel management: a comparative study of an emerging approach to population care. , 2007, The Permanente Journal.

[27]  M. Engelgau,et al.  Measuring progress toward achieving hemoglobin A1c goals in diabetes care: pass/fail or partial credit. , 2007, JAMA.

[28]  Katrina M. Krause,et al.  Primary care: is there enough time for prevention? , 2003, American journal of public health.

[29]  K. Shojania,et al.  Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. , 2006, JAMA.