This cross-sectional survey study measures changes in outpatient quality and patient experience in the United States from 2002 to 2013 to determine whether efforts to improve outpatient quality have been successful.
This cohort study examines associations between medical clinician continuity and health care testing, utilization, and spending of older adults with dementia..
This study evaluates the appropriateness of free-text notes added by prescribers in a nationally representative electronic prescribing system used in ambulatory care.
This population epidemiology study uses medical claims data to assess associations between participation in a US medical home intervention and changes in quality and utilization of care.
This observational study among a nationwide sample of patients reports that primary care provider turnover was associated with worse patient experiences of care but did not have a major effect on ambulatory care quality.
In a retrospective cohort study, Edwards et al characterize the association between enrollment in Home-Based Primary Care, a program operated by the Department of Veterans Affairs, and hospitalizations owing to an ambulatory care–sensitive condition among older veterans with diabetes mellitus. See the Invited Commentary by Federman and Soriano.
Nelson et al create an index that measures the extent of patient-centered medical home implementation, describe variation in implementation, and examine the association between the implementation index and key outcomes. See also the invited commentary by Baron.
Clark et al compare the risk of excessive anticoagulation among patients with stable warfarin therapy purchasing an antibiotic with the risk in patients purchasing a warfarin refill and patients with upper respiratory tract infection but not receiving an antibiotic. Katz provides an editorial.
Nyweide and coauthors determined whether Medicare patients with ambulatory visit patterns indicating higher continuity of care have a lower risk of preventable hospitalization. See the Invited Commentary by Gupta and Bodenheimer.
Rosenthal and coauthors evaluate the effects of the pilot program of a multipayer patient-centered medical home on health care utilization and quality. See the Invited Commentary by Grumbach.
E. A. Wang and coauthors studied the risk for hospitalizations among former inmates soon after their release from correctional facilities.
Electronic health records (EHRs) are increasingly used by US outpatient physicians. They could improve clinical care via clinical decision support (CDS) and electronic guideline–based reminders and alerts. Using nationally representative data, we tested the hypothesis that a higher quality of care would be associated with EHRs and CDS.
We analyzed physician survey data on 255 402 ambulatory patient visits in nonfederal offices and hospitals from the 2005-2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Based on 20 previously developed quality indicators, we assessed the relationship of EHRs and CDS to the provision of guideline-concordant care using multivariable logistic regression.
Electronic health records were used in 30% of an estimated 1.1 billion annual US patient visits. Clinical decision support was present in 57% of these EHR visits (17% of all visits). The use of EHRs and CDS was more likely in the West and in multiphysician settings than in solo practices. In only 1 of 20 indicators was quality greater in EHR visits than in non-EHR visits (diet counseling in high-risk adults, adjusted odds ratio, 1.65; 95% confidence interval, 1.21-2.26). Among the EHR visits, only 1 of 20 quality indicators showed significantly better performance in visits with CDS compared with EHR visits without CDS (lack of routine electrocardiographic ordering in low-risk patients, adjusted odds ratio, 2.88; 95% confidence interval, 1.69-4.90). There were no other significant quality differences.
Our findings indicate no consistent association between EHRs and CDS and better quality. These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality.