Leveraging Electronic Health Records to Develop Measurements for Processes of Care |
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Authors: | Ming Tai‐Seale PhD MPH Caroline J Wilson MSc Laura Panattoni PhD Nidhi Kohli PhD Ashley Stone MPH Dorothy Y Hung PhD MA MPH Sukyung Chung PhD |
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Institution: | 1. Palo Alto Medical Foundation Research Institute, , Palo Alto, CA, 94301;2. Palo Alto Medical Foundation Research Institute, , Mountain View, CA;3. Quantitative Methods in Education Program, Department of Educational Psychology, University of Minnesota, , Minneapolis, MN |
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Abstract: | ObjectivesTo 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 SettingEHR data from 15,370 patients with diabetes, 49,561 with hypertension, in a group practice serving four Northern California counties.Study Design/MethodsExploratory 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 FindingsVolume 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.ConclusionsThe 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. |
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Keywords: | Primary care electronic health records patient‐centered care |
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