Primary care practices can boost clinical preventive services with electronic health records and quality improvement support
Small medical practices that upgrade their electronic health record (EHR) systems to include modules for clinical decision support and practice-level quality improvement substantially boost their delivery of a number of clinical preventive services (CPS), a new study finds. Despite strong evidence that providing CPS reduces morbidity and mortality, provision of CPS has not increased in adult primary care. The researchers studied 56 primary care practices in New York City. Overall, the patient population was 59 percent women, and 55 percent of the patients were age 45 years or older. The most common diagnoses were high blood pressure (hypertension), high blood lipids (dyslipidemia), and diabetes.Across all practices, 7 of 10 CPS measures increased following upgrade of the EHR software. Those measures that increased significantly were blood-glucose screening (from 46 to 62 percent), recording of body-mass index (from 66 to 78 percent), blood-pressure control (from 50 to 55 percent), aspirin therapy to reduce heart attack risk (from 46 to 53 percent), recording smoking status (from 77 to 84 percent), breast cancer screening (from 28 to 32 percent), and influenza vaccination (from 20 to 24 percent). Only smoking-cessation intervention and blood-glucose control measures showed negligible-to-small decreases (a decline of less than 1 percentage point in each case). This study was funded in part by the Agency for Healthcare Research and Quality (HS17059).
More details are in "Health information systems in small practices: Improving the delivery of clinical preventive services," by Sarah C. Shih, M.P.H., Colleen M. McCullough, B.A., Jason J. Wang, Ph.D., and others in the December 2011 American Journal of Preventive Medicine 41(6); pp. 603-609.
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