268766 Trend of quality measures following implementation of electronic health record systems amongst practices in underserved urban areas

Tuesday, October 30, 2012

Jason Wang, PhD , Primary Care Information Project, NYC Department of Health and Mental Hygiene, Long Island City, NY
Colleen McCullough, BA , Primary Care Information Project, NYC Department of Health & Mental Hygiene, Long Island City, NY
Kimberly Sebek, MPH , New York City Department of Health and Mental Hygiene, Primary Care Information Project, Long Island City, NY
Sarah Shih, MPH , Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, NY
  
Background: Previous studies have shown mixed evidence for an association between implementation of electronic health records (EHR) and improvement on quality measures. Little is known about the trend in performance on quality measures for practices in underserved urban areas. Method: Between October 2009 (T1) and October 2011 (T2), monthly data were collected for four quality measures (aspirin therapy, blood pressure (BP) control, smoking cessation intervention, and A1c testing) for 151 practices implementing EHR before July 2009.

Of the 151 practices, 140 were small practices (SP) and 11 were community health centers (CHC). At T2, average monthly unique patients was 742; average number of sites was 1.4; average number of providers was 4.5; average percent of Medicaid or self-insured patients was 33%; and average time using EHR was 37.7 months. There were no statistical differences for these factors between SP and CHC, except for the average number of providers (2.6 vs. 29.3) and average percent of Medicaid or self-insured patients (29.3% vs. 81.8%).

Results: From T1 to T2, average rates increased for aspirin therapy (58.4% to 74.8%); BP control (55.3% to 64.1%); smoking cessation intervention (29.3% to 46.2%); andA1c testing (46.4% to 57.7%). All improvements were statistically significant.

Though both SPs and CHCs had significant improvements for the four quality measures over the two-year period, CHCs made more significant improvements on BP control (CHC: 43.2% to 62.0% vs. SP: 56.6% to 64.3%) and A1c testing (CHC: 33.0% to 72.5% vs. SP: 48.0% to 56.1%). Discussion/conclusions: EHR systems can help both SPs and CHCs in underserved urban areas to improve performance on quality measures over time. With further analysis, practice characteristics or other factors related to improvement can be identified.

Learning Areas:
Chronic disease management and prevention
Public health or related research

Learning Objectives:
Assess the overall trend for quality measures for practices in underserved urban areas after implementation of EHR.

Keywords: Evidence Based Practice, Clinical Prevention Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of Evaluation at the Primary Care Information Project of the New York City Dept of Health and Mental Hygiene. I have been involved in various studies and publications in the field of evaluating the utilization of Electronic Health Records systems.
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.

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