264770 Impact on quality of care after small, physician owned medical practices in NYC adopt a clinical decision support system

Monday, October 29, 2012

Colleen McCullough, BA , Primary Care Information Project, NYC Department of Health & Mental Hygiene, Long Island City, NY
Jason Wang, PhD , Primary Care Information Project, NYC Department of Health and Mental Hygiene, Long Island City, NY
Sarah Shih, MPH , Primary Care Information Project, New York City Department of Health and Mental Hygiene, Long Island City, NY
Background: Small, physician owned practices in medically underserved communities received assistance in adoption of electronic health records (EHR) for quality improvement from the Primary Care Information Project.

Objective: Assess the impact of a clinical decision support system (CDSS) on delivery rates of clinical preventive services (CPS) in small practices using an EHR.

Methods: Retrospective chart reviews of 6,381 patients at 56 practices were used to generate delivery rates before and after the CDSS upgrade of six CPS: aspirin therapy, blood pressure (BP) control, body mass index (BMI) recorded, smoking status recorded, cholesterol screening, hemoglobin A1c (HbA1c) screening. Each CPS had a corresponding CDSS alert, and upon upgrade, practices were randomized to receive some or all of the six alerts.

Results: Across the total patient population, rates of delivery increased significantly (p<.03) for all CPS after the implementation of CDSS (range of increase from 7 to 20 percentage points (pp)). In assessing whether CDSS alerts were associated with further increases of CPS, only two measures aspirin therapy (6.3pp) and BP control (7.6 pp) had significant gains. Across the other CPS measures, increases were observed in all practices, even if they did not receive the alert.

Conclusion: Though the rates of CPS delivery increased significantly across all measures, the impact of CDSS alerts in further increasing CPS delivery was inconclusive. This analysis was limited to a six month period after CDSS was first introduced. Further study is needed to assess whether alerts over a longer period of time would have a positive impact on other CPS measures. Policymakers should exercise caution when evaluating new technology: it is unlikely to provide a quick fix, but over time it can potentially help enhance quality of care after users are given the opportunity to incorporate it into their workflow.

Learning Areas:
Public health or related research

Learning Objectives:
Explain the impact of a clinical decision support system on the delivery of clinical preventive services.

Keywords: Public Health Informatics, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been supporting data collection and analysis for multiple federally funded grants focusing on the use of health information technology to improve quality of care. Among my scientific interests has been the understanding of how quality of preventive primary care can limit preventable hospitalizations and contain health care costs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.