EMR-population care tool combo boosts care, two studies show
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| University of Missouri researchers are developing EHR technology to more meet healthcare demands. Image source: ChartZoom.com |
Those are the findings of two new Kaiser Permanente studies, the first to examine the effectiveness of a population care tool in a large, diverse patient population. The study published in the AJMC found that the Panel Support Tool (PST) helped doctors improve care for patients with diabetes and/or heart disease. The study that appeared in PHM found that the PST also helped doctors provide better preventive care for healthy patients.
The PST, devised and implemented by doctors at Kaiser Permanente, is a web-based tool that compares the care the patient is receiving to the care that is recommended by national guidelines. For example, doctors can query the PST in advance of a patient visit to find out if that patient needs a screening test or vaccine. They can ask the PST to display a list of all of their patients who are overdue for a mammogram or colon cancer screening test or a list of their diabetic patients whose blood sugar levels are too high, or those who need a foot or eye exam.
“Patients in the U.S. receive only about half of the preventive and follow-up care now recommended by national guidelines. Our study shows that, by using the [PST in conjunction with the EMR], we can provide patients with more of the care they are supposed to receive,” said the AJMC study's lead author Adrianne Feldstein, MD, senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore.
The PST makes primary care practice more efficient by addressing the needs of all patients, said the PHM study's lead author Yvonne Zhou, PhD, senior manager of analytics and evaluation at Kaiser Permanente.
The retrospective, longitudinal study in the October issue of AJMC followed 204 primary care teams that were using the PST to manage care for 48,344 patients with diabetes and/or heart disease. After three years, for patients with diabetes, the percentage of care recommendations met every month increased from 67.9 percent to 72.6 percent; for heart disease patients, the percentage rose from 63.5 percent to 70.6 percent.
The AJMC study used 2005 as the pre-intervention, 2006 as the implementation, and 2007 as the post-intervention periods. Care recommendations measured included blood sugar levels, blood pressure screening and control, retinopathy, nephropathy, foot screening, use of aspirin, statins, ACE inhibitors and beta blockers, and influenza and pneumococcal vaccination.
The second study involved 207 primary care teams that were using the PST to manage the care of 263,509 adult patients, some who were relatively healthy and others who had chronic diseases. The study looked at 13 care recommendations and found that after 20 months, the PST improved performance from 72.9 percent to an average of 80 percent.
Researchers found that during the first year of tool use, performance in delivering the care recommendations improved to a statistically significant degree every four months.