- A quality improvement program combining EHR-integrated tools and patient engagement strategies can significantly improve quality of care for patients with chronic kidney disease, according to new research published in the American Journal of Managed Care (AJMC).
Over a one-year period, Sequist et al. observed 153 primary care physicians treating 3,947 high-risk patients and 3,744 low-risk patients with stage III chronic kidney disease across 13 ambulatory health centers at Harvard Vanguard Medical Associates in Massachusetts.
As part of the study, participating physicians received a set of EHR-integrated alerts through the practice’s Epic EHR system during office visits. These EHR alerts provided physicians with recommendations for risk-appropriate chronic kidney disease care.
When treating high-risk patients, physicians received EHR alerts recommending a referral to a nephrologist if the patient had not visited the specialist in the past 12 months.
Physicians treating high-risk patients also received an EHR alert recommending specific prescriptions if the patient had a diagnosis of hypertension or albuminuria and had not been prescribed the medications in the last year.
For low-risk patients, physicians received prescription recommendation alerts as well as alerts suggesting certain overdue lab tests.
Meanwhile, participating patients received educational materials by mail providing treatment recommendations based on information gleaned from their EHRs. Mailings ranged from reminders to request overdue lab tests and follow-ups to educational materials about current medications.
Ultimately, researchers found low-risk patients who had participated in the quality improvement program were about 25 percent more likely to have received urine microalbumin testing than patients not enrolled in the program.
Additionally, participating high-risk patients were over 10 percent more likely to have seen a nephrologist in the past 12 months than those not enrolled in the program. Furthermore, both high and low-risk patients enrolled in the program showed higher rates of annual testing for vitamin D, phosphorus, and parathyroid hormone than those who did not participate.
“In a large randomized controlled trial of patients with stage III CKD, we demonstrated that a quality improvement program consisting of electronic decision support combined with mailed patient self-management support tools significantly improved quality of care, including use of nephrology referrals and laboratory testing,” stated researchers in the report.
Researchers emphasized the effectiveness of patient engagement among patients with chronic kidney disease. The team noted a substantial portion of study participants had not been informed of their disease prior to the study, and stressed the importance of ensuring patients are aware of their diagnoses.
“The National Kidney Foundation and various federal agencies have also supported population-based programs to improve awareness of CKD, including detection and treatment,” wrote researchers.
“Our program builds on these efforts by combining a program to increase diagnosis and awareness with a set of EHR tools embedded within the workflows of a delivery system to support proactive CKD management,” the team continued.
While the program pairing EHR-integrated clinical decision support tools and patient engagement strategies proved successful in some areas, it had little effect on other aspects of treatment. In particular, physician prescribing of medications remained consistent between all physicians regardless of program participation.
Overall, researchers determined EHR use and patient engagement can be effectively leveraged to improve quality of care in some areas.
“Future work should explore how EHRs can be used to improve provider and patient decision making and further collaboration among patients, PCPs, and specialist physicians as part of a comprehensive effort to improve health outcomes and value,” concluded the research team.
While EHR use served as a boon to quality care in this instance, another recent study in the Journal of the American Heart Association (JAHA) found EHR use to be insufficient in improving health outcomes for patients with heart failure.
Selvaraj et al. examined health outcomes for 21,222 patient participants of the Get With the Guidelines heart failure registry admitted to hospitals in 2008.
Hospitals treating patients part of the registry engaged in varying levels of EHR use, with some hospitals operating without an EHR system in place and others using a full suite of EHR solutions.
Researchers analyzed the relationship between level of EHR use and several in-hospital quality metrics and outcomes. Ultimately, the team found there was no significant association between level of EHR use and improvements in patient health outcomes.
Most notably, EHR use had no substantial impact on reducing 30-day mortality or hospital readmission rates among Medicare patients. These findings contradict widely-held beliefs about the potential for EHR technology to yield significant improvements in treatment following HITECH and widespread EHR adoption.
Though EHR technology has a ways to go before fulfilling industry expectations, continued EHR optimization efforts may help healthcare organizations to get the most out of their systems.