The proprietary, Web-based Panel Support Tool (PST) extracts data from electronic medical records (EMRs) to help primary care providers (PCPs) improve care and manage their entire patient panel, according to the results of 2 Kaiser Permanente studies. The first study, reported in the October issue of the American Journal of Managed Care, looked at how the PST could improve care for patients with diabetes mellitus (DM) and/or cardiovascular disease (CVD). The other study, published in Population Health Management, showed that the PST also helped physicians provide better preventive care for healthy patients.
"Patients in the U.S. receive only about half of the preventive and follow-up care now recommended by national guidelines," Adrianne Feldstein, MD, MS, lead author of the American Journal of Managed Care study and senior investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon, said in a news release. "Our study shows that, by using the innovative [PST], in conjunction with the [EMR], we can provide patients with more of the care they are supposed to receive."
PST Improves Care Delivery for Patients With DM and CVD
The goal of this retrospective, longitudinal cohort study was to assess the effect of the PST on care delivery by PCPs for patients with DM and/or CVD, using 2005 as the preintervention period, 2006 as the implementation period, and 2007 as the postintervention period. By comparing the care the patient was receiving with care recommended by national guidelines, the PST displayed "care gaps" and offered recommendations for glycosylated hemoglobin, low-density lipoprotein cholesterol, and blood pressure screening and control; retinopathy, nephropathy, and foot screening; aspirin, statin, and angiotensin converting enzyme inhibitor or beta-blocker use; and influenza and pneumococcal vaccination.
EMR data and hierarchical linear models were used to estimate the intervention effect among qualifying PCPs and health maintenance organization patients who had DM (n = 30,273) or CVD (n = 26,414) and 12 months of membership. The care score measured mean percentages of care recommendations met by PCPs per patient per month.
From 2005 to 2007, the mean care score for DM increased from 63.5 (95% confidence interval [CI], 62.7 - 64.3) to 70.6 (95% CI, 69.8 - 71.4). For CVD, the mean care score increased from 67.9 (95% CI, 67.2 - 68.7) to 72.6 (95% CI, 71.9 - 73.3). In 2007 compared with 2005, DM and CVD patients had care score improvements of 7.6 and 5.1, respectively, after adjustments (P < .001).
"Delivery of care recommendations for DM and CVD improved after implementation of a PST," the study authors write. "More research is necessary to optimize results and determine whether patient outcomes improve."
Limitations of this study include a lack of randomization and the possible lack of generalizability beyond this single institution.
Effect of PST on Preventive Care for Healthy Individuals
"Doctors and staff love the [PST] because it makes primary care practice more efficient by addressing the needs of all of their patients," said Yvonne Zhou, PhD, lead author of the second study and senior manager of analytics and evaluation at Kaiser Permanente. "Harnessing the power of immediately available and complete patient information, the PST allows [PCPs] to rapidly examine what is recommended for an individual patient, a group of patients with a specific condition, or their entire panel of patients."
This retrospective, serial cross-sectional study evaluated the effect of the PST on performance of primary care teams on preventive, monitoring, and therapeutic evidence-based recommendations. The PST was able to identify care gaps for individual patients, groups of patients selected by a provider, or all patients on a PCP's panel. In addition, it combined point-of-care recommendations, disease registry capabilities, and continuous performance feedback for providers.
Using monthly summary data, this study examined the PST's effect on care performance for 207 teams caring for 263,509 adult members in Kaiser Permanente's Northwest region. The investigators measured care performance at baseline (3 months before first PST use) and every 4 months during a 20-month follow-up.
A monthly care performance percentage for each provider was the primary study endpoint. This was calculated from the number of selected care recommendations completed for all patients, divided by the number of clinical indications for care recommendations among them. The t-test and multiple regression were used for statistical analysis.
At baseline, average care performance on the 13 measures evaluated was 72.9% (95% CI, 71.8% - 74.0%); this improved significantly every 4 months during the first 12 months of PST use. Average care performance was 80.0% (95% CI, 79.3% - 80.7%) after 20 months of follow-up.
Study limitations include the lack of a control group and randomization, significant variation in operations among the practices in different regions, and the failure to address health outcomes.
"A PST, integrating point-of-care decision supports, population care management functions, and performance feedback with a comprehensive electronic health record, is an effective tool to improve performance on evidence-based care guidelines," the study authors write.
A Kaiser Permanente EMR research initiative supported these studies. The study authors have disclosed no relevant financial relationships.
Am J Manag Care. 2010;16:e256-e266. Popul Health Manag. Published online October 1, 2010.
Laurie Barclay, MD • Medscape Medical News © 2010 WebMD, LLC