Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1017 — Application of Information-Technology in the Management of Patients with Diabetes Mellitus

Chou AF (University of Oklahoma) , Sutherland JM (Indianapolis VA- COE), McCoy K (Indianapolis VA- COE), Jones LE (Indianapolis VA- COE), Doebbeling BN (Indianapolis VA- COE)

Objectives:
The Institute of Medicine’s Quality Chasm report identified 6 dimensions of information technology (IT) as critical components for quality improvement. VA has been a leader in the field for IT adoption and implementation. However, the utility of IT in chronic disease management has not been fully addressed. This study evaluates the impact of IT use on outcomes related to processes of care in managing patients with diabetes mellitus (DM).

Methods:
A national sample of 2,438 VA clinicians was surveyed to rate the utility, availability, and effectiveness of IT tools on care and reported practices surrounding DM management. Factor analysis yielded an IT factor assessing the extent to which the hospital provided IT for computer-assisted decision support systems, computerized patient data, decision automation, on-line literature access, and electronic provider-to-provider communication. We employed multivariate models using a stepwise regression analysis with backward selection to estimate appropriate HbA1c, dilated fundoscopy exam (DFE), and urine protein checks performed as a function of availability of clinical reminders (CR), the IT factor, and frequency of feedback, controlling for provider demographic and practice characteristics.

Results:
Increased frequency of receiving feedback (p < 0.0001), availability of CR (p < 0.0001), and the IT factor (p < 0.0001) were positively associated with HbA1c checks. Appropriate DFE was positively related to increased frequency of receiving feedback (p < 0.0001), CR (p < 0.0001), and IT factor (p < 0.0001). Urine protein checks were positively associated with increased frequency of receiving feedback (p < 0.0001), CR (p < 0.0001), and IT factor (p = 0.0003).

Implications:
These findings suggest that routine and regular feedback to providers, availability of CR, and computer-assisted tools facilitated appropriate management of DM.

Impacts:
IT supports rapid dissemination of information, and broad and immediate information access. IT encourages information sharing and use, integration of systems and functions, and linking with various environments. IT tools hold promise for facilitating decision-making and closing knowledge gaps between evidence-based and modal care for chronic disease management. Further understanding of IT’s impact on care can identify conditions conducive to IT utilization, focus and refine efforts in IT implementation.