Relationship Between Electronic Health Record Use and Health Counseling: Will Meaningful Use Improve Counseling Services?
Kurth, Kelsey Anne
Following the enactment of the Medicare and Medicaid Electronic Health Record Incentive programs in 2009, several studies have sought to determine if there is a relationship between the use of electronic health records and the quality of care patients receive. The results of these studies have been mixed, and the most conclusive findings of positive correlation are currently found in cohort studies that are not generalizable to all U.S. physicians. This study seeks to build on previous efforts by looking at the relationship between the use of electronic health records and the provision of preventive health counseling to at risk patients using the National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of U.S. patient visits. This paper finds that patients with high blood pressure were twice as likely to receive diet and nutrition counseling during their visit when their physician had a system for electronic clinical reminders. When compared to visits with patients who did not have high blood pressure and where no clinical reminders were used, visits with patients who had high blood pressure had 42 percent higher odds of including diet and nutrition counseling when clinical reminders were present. Though there was no evidence of increased counseling among obese patients, visits with obese patients where clinical reminders were available had 18 percent higher odds of including exercise counseling than visits with non-obese patients without clinical reminders (p=0.005). In general, patients with risk factors have an increased odds of receiving preventive counseling of 17 percent when their physician utilized a system for electronic clinical reminders (p=0.002), compared to patients with no risk factors and no clinical reminders. The gains in diet and nutrition and exercise counseling were generally appropriate to the patient in model simulations, suggesting efficient care.
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