Electronic health record use and the quality of ambulatory care in the United States

被引:304
作者
Linder, Jeffrey A.
Ma, Jun
Bates, David W.
Middleton, Blackford
Stafford, Randall S.
机构
[1] Brigham & Womens Hosp, Div Gen Med, Boston, MA 02120 USA
[2] Harvard Univ, Sch Med, Boston, MA 02115 USA
[3] Stanford Univ, Program Prevent Outcomes & Practices, Stanford Prevent Res Ctr, Stanford, CA 94305 USA
关键词
D O I
10.1001/archinte.167.13.1400
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. We assessed the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey. Methods: We performed a retrospective, cross-sectional analysis of visits in the 2003 and 2004 National Ambulatory Medical Care Survey. We examined EHR use throughout the United States and the association of EHR use with 17 ambulatory quality indicators. Performance on quality indicators was defined as the percentage of applicable visits in which patients received recommended care. Results: Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P = .01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P = .003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P = .01). Conclusion: As implemented, EHRs were not associated with better quality ambulatory care.
引用
收藏
页码:1400 / 1405
页数:6
相关论文
共 27 条
[1]  
[Anonymous], 2001, CROSS QUAL CHASM NEW
[2]  
[Anonymous], 2005, ELECT MED RECORD USE
[3]   Electronic technology - A spark to revitalize primary care? [J].
Bodenheimer, T ;
Grumbach, K .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 290 (02) :259-264
[4]   Improving primary care for patients with chronic illness [J].
Bodenheimer, T ;
Wagner, EH ;
Grumbach, K .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 288 (14) :1775-1779
[5]   Which physicians and practices are using electronic medical records? [J].
Burt, CW ;
Sisk, JE .
HEALTH AFFAIRS, 2005, 24 (05) :1334-1343
[6]  
BURT CW, 2001, USE COMPUTERIZED CLI
[7]   Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care [J].
Chaudhry, Basit ;
Wang, Jerome ;
Wu, Shinyi ;
Maglione, Margaret ;
Mojica, Walter ;
Roth, Elizabeth ;
Morton, Sally C. ;
Shekelle, Paul G. .
ANNALS OF INTERNAL MEDICINE, 2006, 144 (10) :742-752
[8]   Four rules for the reinvention of health care [J].
Coiera, E .
BRITISH MEDICAL JOURNAL, 2004, 328 (7449) :1197-1199
[9]   Pay-for-performance programs in family practices in the United Kingdom [J].
Doran, Tim ;
Fullwood, Catherine ;
Gravelle, Hugh ;
Reeves, David ;
Kontopantelis, Evangelos ;
Hiroeh, Urara ;
Roland, Martin .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (04) :375-384
[10]  
Food and Drug Administration, 1995, NAT DRUG COD DIR