Web-based Tool Helps Physicians Narrow Care Gaps for Patients with Chronic Illnesses

Authors noted increased percentage of care
recommendations met

Treatment guidelines for patients with chronic illnesses, such as diabetes mellitus (DM) and cardiovascular disease (CVD), call for more preventive care, screening, and medications than the average patient. Yet studies have shown that about half of these types of patients aren’t receiving the kind of care outlined in guidelines. But how do you identify the patients who aren’t? A study recently published in the American Journal of Managed Care suggests that help may be on the way. The study found that a web-based tool that draws information from electronic medical records (EMRs) to identify gaps in care was effective at improving care for DM and CVD patients.

DM and CVD patients who do not receive preventive and follow-up care recommended by national guidelines are more likely to experience poorer outcomes and increased health care costs. Electronic tools such as alerts, reminders, and embedded guidelines advice, have been shown to improve care by using EMR information. But these tools have been limited. The authors of the current study concluded that, especially for managing patients with chronic conditions, electronic tools need a broader scope. They undertook the current study to evaluate a web-based panel-support tool (PST) on the delivery of care recommendations by primary care physicians (PCPs) for patients with DM and/or CVD.

Implemented in 2006, the PST draws on EMR data to graphically display gaps in care for patients based on current evidence-based guidelines. It also provides summary information to assist practitioners and care teams in evaluating the gaps and ordering needed services. The authors conducted the retrospective, longitudinal cohort study in 2008, with 2005 as the pre-intervention period, 2006 as the implementation period, and 2007 as the post-intervention period, and estimated the intervention effect using EMR data and linear models. The main measure was the care score, defined as the mean percentages of care recommendations that were met by PCPs per patient per month. The researchers identified 204 PCPs with 48,344 patients who had DM or CVD or both. The authors then assessed whether the following care recommendations were fulfilled for every patient for every month:

• Screening (LDL-C, blood pressure, glycosylated hemoglobin [A1C], retinopathy, nephropathy, and foot screening);
• Medication use (aspirin, statins, ACE inhibitors, and beta-blockers); and
• Influenza and pneumococcal vaccinations.

From 2005 to 2007, the mean care score increased for both DM and CVD, from 67.9 percent to 72.6 percent for DM and from 63.5 percent to 70.6 percent for CVD. After adjustments, DM and CVD patients had improvements in the care score of 7.6 and 5.1, respectively in 2007 compared with 2005.

The authors write that “to our knowledge, this is the first study to find that a PST can be successfully integrated into care of large populations of patients with DM and CVD to improve delivery of patient care recommendations. Given that gaps in the delivery of care for these complex patients are common, the implementation of a PST could have a substantial impact on patient care,” they conclude.

Source: Feldstein AC, Perrin NA, Unitan R, et al. 2010. Effect of a patient panel-support tool on care delivery. American Journal of Managed Care 16(10):e256-e266.