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Components and Items Adherence Measures Assessment Assessment HbA1c in the past 6 months Acceptable: at least 3 of the items completed LDL in the past 12 months Microalbumin in the past 12 months BP at every visit Smoking status ever assessed Treatment Treatment HbA1c ≤8% or >8% and on a hypoglycemic agent Acceptable: all items adhered to LDL ≤100 or >100 and on a lipid-lowering agent BP ≤130/85 or >130/85 and on an antihypertensive Urine microalbumin >30 and on angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker Target Target HbA1c ≤7% Acceptable: all values achieved LDL ≤t00 Partial: any 2 values achieved BP ≤130/85 - Table 2.
OR, P values, and 95% CI for the effect of Clinical Information Systems Use (Measured as an Average of Clinician Usage Scores on Adherence to Diabetes Care Guidelines, Controlling for Patient- and Practice-Level Covariates)*
OR Value of P CI for OR Identification of Patients Assessment 0.79† 0.207 0.55, 1.14 Treatment 0.74 0.098 0.87, 1.06 Target (2 of 3) 1.23 0.007 1.06, 1.44 Target (all 3) 1.22 0.192 0.91, 1.63 Tracking Systems Assessment 1.10 0.567 0.80, 1.51 Treatment 1.15 0.330 0.87, 1.51 Target (2 of 3) 1.32 0.002 1.11, 1.59 Target (all 3) 1.28 0.100 0.95, 1.73 * Patient level covariates included age, gender, whether the person had a heart condition and/or hypertension. Practice level covariates included whether the practice uses an EMR and whether the practice is a solo or group practice.
† For a 1-point increase in the score for “identification of patients” (on a scale of 1 to 5), the odds of appropriate assessment decrease by 21%.
- Table 3.
OR and P Values Describing the Effect of Clinical Information Systems Use (Measured as an Average of Clinician Usage Scores) on Adherence to Diabetes Care Guidelines Among Patients With and Without Comorbid Conditions*
Identification of Patients Tracking Systems OR Value of P OR Value of P Assessment Heart Condition 1.08† 0.768 1.02 0.966 Hypertension 0.80 0.247 0.97 0.865 Neither 0.70 0.188 1.50 0.030‡ Treatment Heart Condition 1.12 0.925 1.27 0.468 Hypertension 0.62 0.015§ 1.27 0.095‡ Neither 0.78 0.368 1.17 0.466 Target (2 of 3) Heart Condition 1.34 0.292 1.12 0.481 Hypertension 1.13 0.284 1.42 0.010‡ Neither 1.44 0.049‡ 1.14 0.274 Target (all 3) Heart Condition 2.30 0.029‡ 1.12 0.720 Hypertension 1.08 0.651 1.46 0.027‡ Neither 1.39 0.201 1.25 0.305 * Patient-level covariates included age and gender; practice-level covariates included whether the practice uses an EMR and whether the practice is a solo or group practice.
† Among patients with a heart condition, the odds of appropriate assessment according to guidelines increased by 8% with a 1-point increase (on a scale of 1 to 5) for use of patient identification systems. (Not significant, P = 0.768.)
‡ Use of information system component associated with improved diabetes care.
§ Use of information system component associated with decreased diabetes care.
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