CHR Research Finds That User-Friendly Tool in KPNW's Electronic Medical Record Improves Care Delivery
Kaiser Permanente Northwest primary care physicians using the "Panel Support Tool" meet more care recommendations for patients with chronic disease
(PORTLAND, Ore.)—Newly published research—led by CHR investigator and KPNW Director of Population Care Adrianne Feldstein, MD, MS—demonstrates that KPNW’s Panel Support Tool improves care for members who have cardiovascular disease (CVD) and Type 2 diabetes. The article appears in the October issue of The American Journal of Managed Care.
Like all patients with chronic disease, those with CVD and diabetes need a lot of help from their primary care providers to oversee screening, preventive medication, vaccines, and risk-factor control. Unfortunately, only about half these patients, nationwide, get the recommended care they should have. Those who don’t face potentially dangerous gaps that can worsen outcomes and increase health care costs.
Dr. Feldstein wanted to know whether a user-friendly tool in HealthConnect—called the Panel Support Tool (PST)—could improve primary-care delivery for diabetes and CVD. Nested within our electronic medical record (EMR) system, the PST is a “quality dashboard” that helps clinicians interpret EMR data more efficiently by graphically displaying “care gaps” for each patient (based on current evidence and national guidelines). The PST also provides summary information to help practitioners and care teams evaluate gaps and order and prioritize needed services; this information is color coded (red for urgent, for example) to facilitate prioritization.
At KPNW, the PST was implemented in 2006. By August 2006, half of our teams were using the PST; 65% were using it by December 2006; and more than 95% by February 2007. Dr. Feldstein conducted her three-year retrospective study around PST implementation. Her goal was to calculate the mean percent of recommendations met—or “care score”—for every CVD and diabetes patient for every month in 2005, 2006, and 2007.
First, the research team identified 204 KPNW primary care physicians who had eligible diabetes and CVD patients before, during, and after PST implementation. Then the investigators assessed—for every patient (there were 48,344 unique individuals), for every month—whether the following care recommendations were fulfilled: screening (for levels of blood sugar, lipids, cholesterol, blood pressure, retinopathy, nephropathy, and for foot care); medication use (aspirin, statins, and angiotensin converting enzyme inhibitors or beta blockers); and influenza and pneumococcal vaccinations.
Here’s what they found over the three-year period. For patients with diabetes, the care score increased from 67.9% to 72.6%. For CVD patients, the care score rose from 63.5% to 70.6%. (This compares favorably to how well care recommendations are met in the community; again, the percentage hovers around 50%.)
After adjustments, from 2005 to 2007, the care score for KPNW diabetes patients rose 7.6%; for CVD patients, it increased 5.1%. Interestingly, Dr. Feldstein and her team found that care scores increased in 2006 but accelerated even faster in 2007, indicating that PST use is on an upward trend.
The next step will be to evaluate the qualitative findings of this research. Dr. Feldstein is preparing a new paper that characterizes the attributes of primary care physicians and care teams who use the PST particularly well—or particularly poorly. She and her coauthors are analyzing survey and focus group data to learn why some teams found the PST overwhelming while others found it helpful.
Study authors include: CHR’s Nancy Perrin, PhD, Gabriela Rosales, MS, Gregory Nichols, PhD, David H. Smith, RPh, MHA, PhD, Jennifer Schneider, MPH; from KPNW, Robert Unitan, MD, Carrie Davino, MD, Yvonne Zhou, PhD, and Nancy Louie Lee, RPh.
View the press release.
Kaiser Permanente’s Center for Health Research, founded in 1964, is a non-profit research institution whose mission is advancing knowledge to improve health. It has research sites in Portland OR; Honolulu, HI; and Atlanta, GA. www.kpchr.org
Kaiser Permanente is America’s leading integrated health care organization. Founded in 1945, the organization serves the health needs of more than 8.7 million people nationwide. Nearly 480,000 people in Oregon and Southwest Washington receive their health care from Kaiser Permanente. www.kaiserpermanente.org
For more information contact:
Mary Sawyers, (503) 335-6602, Mary.A.Sawyers@kpchr.org or
Gail Mathabane, (503) 758-9024, Gail.Mathabane@kpchr.org