New Research Finds EHRs Improve the Quality of Diabetes Care

Randall D. Cebul, MD, Director, Better Health Greater Cleveland | September 1, 2011

Two years ago in an address to Congress, President Obama declared his commitment to invest in electronic health records (EHRs), saying he thought it was perhaps the best way to quickly improve the quality of American health care. Just two years later, that hunch is proving true in Cleveland, Ohio.

New EHR Research Findings:

Today, the New England Journal of Medicine released research authored by my colleagues and me at Better Health Greater Cleveland showing that physician practices that use electronic health records had significantly higher achievement and improvement in meeting standards of care and outcomes in diabetes than practices using paper records.

Though most of us assumed EHRs would have some effect on patient care, we were delighted by what’s proving to be the reality in greater Cleveland. Just consider:

Care is better: Nearly 51% of patients in EHR practices received care that met all of the endorsed standards.

  • Only 7% of patients at paper-based practices received this same level of care– a difference of 44%.
  • After accounting for differences in patient characteristics between EHR and paper-based practices, EHR patients still received 35% more of the care standards.
  • Just fewer than 16% of patients at paper-based practices had comparable results.
  • After accounting for patient differences, the adjusted gap remained 15% higher for EHR practices.

Outcomes are better: Nearly 44 % of patients in EHR practices met at least four of five outcome standards for diabetes.

Improvement is faster: EHR practices had annual improvements in care that were 10% greater and improvements in outcomes that were 4% greater than those of paper-based practices.

Everyone benefits: Patients in EHR practices showed better results regardless of their insurance status, whether privately insured, uninsured, or covered by Medicare or Medicaid. Thus, all payers benefited too.

EHR Research Participants:

The research involved more than 27,000 adults with diabetes who received care in 46 practices across the Cleveland metro area.

The work was fueled by being selected one of the Robert Wood Johnson Foundation’s Aligning Forces for Quality communities. All 16 committed to public reporting and improving care for their patients with chronic medical conditions.

In the Cleveland area, the improvements we report would not have been possible without the more than 500 courageous doctors who stepped up and made the commitment to work directly with Better Health Greater Cleveland to share best practices in care and publicly report their achievement.

Most inspiring were the contributions of the region’s Federally Qualified Health Centers – who care for some of the most vulnerable people in the area and who have committed to compete head-to-head with health care organizations with substantially more advantaged patients.

Not surprisingly, all of our paper-based safety net practices have capitalized on federal funds and resources to acquire EHRs and to leverage involvement with Better Health to accelerate their quality-related improvements. We look forward to helping out.

Positive Outcomes:

EHRs aren’t the end-all-be-all solution for all the gaps in quality facing American health care, and they require significant commitment and teamwork from health care providers to implement them – not to mention encouragement and support from the government.

But results from our study provide optimism that the President’s faith is well-placed. Here in Cleveland, we’re working to make our region a healthier place to live and a better place to do business.