Diabetics received better care at medical practices with an electronic health record that those reliant on paper, says a study published Aug. 31 in The New England Journal of Medicine.

The study, by Randall D. Cebul, Thomas E. Love, Anil K. Jain, and Christopher J. Hebert, contrasts with previous studies that have found that EHRs have no consistent association with higher-quality care. Congress has approved as much as $27.4 billion to subsidize caregiver adoption of EHRs.

The study examines whether practices in metro Cleveland provided standardized diabetes quality care measures, such as an eye examination to screen for retinopathy, and intermediate-outcome standards, such as a body-mass index below 30. Practices included in the study are responsible for the majority of chronic disease care in Cuyahoga County.

When adjusting the results to account for differences in education, estimated income, ethnicity, insurance type, age and gender, study authors say achievement of quality care measures was 35.1 percentage points higher at EHR sites than at paper-based sites, and achievement of outcomes was 15.2 percentage points higher. The numbers are at the 95 percent confidence interval.

But, the paper cautions that inferring that EHRs fully account for the observed differences in quality "is not warranted, in part because of the participation of exceptional EHR-based organizations, a nonrepresentative sample of paper-based organizations, and inadequate adjustment for patient characteristics."

The findings, study authors allow, compare results in organizations with sophisticated EHRs to paper-based organizations that also serve a vulnerable patient population "and may have fewer quality-related resources than other paper-based practices." Still, an analysis of outcomes just among practices that serve "safety-net" patients produced similar results, the paper says.

A comparison of outcomes at the same practice before and after conversion to electronic records would provide more compelling evidence of the benefits of EHRs, the paper adds.

For more:
- download the article "Electronic Health Records and Quality of Diabetes Care" from the New England Journal of Medicine

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