Quality improvement techniques can be combined with electronic health records (EHRs) to improve care for patients with coronary artery disease (CAD), according to a new study. The researchers found that electronic reminders were not sufficient to improve outpatient care for these patients. Instead, physicians responded more when feedback reports and financial incentives were added.
Four primary care practices using EHRs for 5 years participated in the study. The researchers selected four measures of CAD care quality. The first two were antiplatelet and lipid-lowering drug therapy for all patients with heart disease. The last two were the use of beta-blockers and the use of either an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) after a heart attack.
In the first half of the study, physicians received electronic reminders prompting them to order the medications or record reasons (exceptions) why they were not prescribed. In the second study phase, physicians received performance reports that included lists of patients where the quality measures were not satisfied. They were also told that 1.5 percent of their total compensation would be tied to their performance on multiple quality measures (of which these 4 measures were a part). During the first phase where just electronic reminders were used, performance improved slightly for 3 measures: antiplatelet, beta-blocker, and ACE inhibitor/ARB medications.
After the second phase, performance improved significantly on all four measures. There was also a significant increase in the number of physicians recording exceptions to prescribing on all four measures, and a rise in the number of patients for whom antiplatelet use was recorded on their medication lists.
The study was supported part by AHRQ (HS17163 and HS15647). See "Implementation of EHR-based strategies to improve outpatient CAD care," by Stephen D. Persell, M.D., M.P.H., Janardan Khandekar, M.D., Thomas Gavagan, M.D., and others in the October 2012 The American Journal of Managed Care 18(10), pp. 603-610.