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Health Serv Res. 2014 Apr;49(2):628-44. doi: 10.1111/1475-6773.12126. Epub 2013 Nov 18.

Leveraging electronic health records to develop measurements for processes of care.

Author information

1
Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301.

Abstract

OBJECTIVES:

To assess the reliability of data in electronic health records (EHRs) for measuring processes of care among primary care physicians (PCPs) and examine the relationship between these measures and clinical outcomes.

DATA SOURCES/STUDY SETTING:

EHR data from 15,370 patients with diabetes, 49,561 with hypertension, in a group practice serving four Northern California counties.

STUDY DESIGN/METHODS:

Exploratory factor analysis (EFA) and multilevel analyses of the relationships between processes of care variables and factor scales with control of hemoglobin A1c, blood pressure (BP), and low density lipoprotein (LDL) among patients with diabetes and BP among patients with hypertension.

PRINCIPAL FINDINGS:

Volume of e-messages, number of days to the third-next-available appointment, and team communication emerged as reliable factors of PCP processes of care in EFA (Cronbach's alpha=0.73, 0.62, and 0.91). Volume of e-messages was associated with higher odds of LDL control (≤100) (OR=1.13, p<.05) among patients with diabetes. Frequent in-person visits were associated with better BP (OR=1.02, p<.01) and LDL control (OR=1.01, p<.01) among patients with diabetes, and better BP control (OR=1.04, p<.01) among patients with hypertension.

CONCLUSIONS:

The EHR offers process of care measures which can augment patient-reported measures of patient-centeredness. Two of them are significantly associated with clinical outcomes. Future research should examine their association with additional outcomes.

KEYWORDS:

Primary care; electronic health records; patient-centered care

PMID:
24236994
PMCID:
PMC3976190
DOI:
10.1111/1475-6773.12126
[Indexed for MEDLINE]
Free PMC Article

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