Patients cared for by clinicians who reported being part of a “high cohesion” team using electronic health records, or EHRs, saw significantly greater improvements in HbA1c levels and a greater decrease in LDL cholesterol than patients cared for by clinicians in a “low cohesion” team, according to research in the American Journal of Managed Care.
“Through the Meaningful Use incentive payment program, the federal government has invested substantially in promoting the widespread use EHRs,” Ilana Graetz, PhD, assistant professor of health services and policy research at the University of Tennessee Health Science Center, told Endocrine Today. “Nonetheless, the evidence on the impact of EHR use on diabetes clinical outcomes remains mixed.”
Graetz and colleagues analyzed data from 104 primary care teams in the Kaiser Permanente Northern California integrated delivery system (mean team size, 15.4 members; mean of 11.8 primary care providers per team; mean of 7.5 respondents per team), as well as 80,611 patients in the health plan’s clinical diabetes registry at the beginning of 2004. Researchers sent primary care team members a survey regarding team cohesion in 2005 asking participants to describe the quality of working relationships and communication among team members; response options included a 5-point Likert-like agreement scale and were averaged over four team cohesion items and again across members from the same team. The mean team cohesion score was 3.71.
Researchers used delivery-system administrative data to link patients to their primary care provider and team, and used the health plan’s automated lab data to collect HbA1c and LDL cholesterol values for patients in the cohort between 2005 and 2009.
Researchers found that the use of EHRs among higher cohesion teams was associated with a mean 0.11% decrease in HbA1c (95% CI, –0.12 to –0.09) vs. a 0.08% decrease in HbA1c found in lower cohesion teams (95% CI, –0.1 to –0.07). Patients cared for by higher cohesion teams using EHRs also saw an improvement in LDL cholesterol when compared with patients cared for by lower cohesion teams (2.15 mg/dL vs. 1.42 mg/dL).
“Our findings highlight the importance of the organizational environment, such as team cohesion, in the successful adoption of new technologies and practices,” Graetz told Endocrine Today. “Identifying opportunities to improve team relationships in the work environment may enhance the effect of EHRs on care quality.” – by Regina Schaffer
One of the researchers is an employee of Kaiser Permanente; another is a member of the Kaiser Permanente advisory board.