Electronic Health Records Are Linked to Higher-Quality Care in Primary Practices
Problems with quality of care in the United States have been well documented. Primary care physicians have been encouraged to address quality gaps by investing in electronic health records and other new capabilities. Are these investments paying off? A team led by RAND researcher Mark Friedberg examined the relationship between the use of new capabilities and the quality of primary care. The researchers surveyed 305 Massachusetts primary care practices to assess their use of 13 recommended capabilities, including electronic health records, sending reminders about needed services, and offering appointments on weekends. They then examined how these capabilities related to quality in four areas: diabetes treatment, depression care, overuse of medical technology, and preventive health screenings.
The study found that, of all the capabilities, electronic health records were associated with the greatest quality improvements in the most areas: breast cancer screening, colorectal cancer screening, chlamydia screening, and diabetes care. Electronic health record systems were linked to the highest quality when they included advanced functions such as electronic reminders to physicians. More rudimentary systems were associated with smaller performance improvements in fewer areas.
The study is among the first to show a connection between electronic health records and higher-quality care in community-based primary practices. It has implications for the interpretation of recent federal legislation, which gives physicians incentives to make "meaningful use" of electronic health records. Since electronic health records may have stronger effects on quality when they include advanced functions, use of these advanced functions should be considered among the criteria for defining "meaningful use."
Faulty Premises Underlie Moratorium on Fast-Food Chains in South L.A.
Obesity takes a disproportionate toll on poor and minority neighborhoods. In South L.A., a large low-income area of Los Angeles, excessive obesity rates moved the L.A. City Council in July 2008 to try a novel approach aimed at improving residents' health. The council passed a one-year moratorium on opening or expanding fast-food chain restaurants, a move in tune with the popular notion that neighborhoods overrun with fast-food chains have a toxic food environment.
However, the premises for the ban—that limiting fast-food restaurants in South L.A. will improve nutrition and reduce obesity rates—appear flawed. A RAND team led by economist Roland Sturm and physician-researcher Deborah Cohen examined the empirical evidence. They found that South L.A. has fewer, not more, fast-food chains per capita than wealthier sections of the city. What is nutritionally different about South L.A. is that residents consume significantly more snack calories, with about half the difference coming from soda.
The researchers suggest that better health outcomes for South L.A. residents might be realized by focusing on the availability of candy, cookies, and sodas sold in both food and nonfood establishments. A focus on reducing portion sizes and the consumption of foods with little nutrient value may be more promising than banning fast-food chains.
Parental HIV Poses Difficult Challenges for Children
HIV can significantly affect the families of individuals diagnosed with the condition, particularly the children of parents with HIV. Research conducted by RAND and collaborating institutions examined the challenges confronting these children. The study used data from the HIV Cost and Services Utilization Study (HCSUS), the first comprehensive and nationally representative U.S. survey of people in care for HIV.
The analysis found that, like other children with a seriously ill parent, children with HIV-infected parents are vulnerable to emotional and behavioral issues. They also face unique challenges specifically related to their parents' HIV status.
- Due to misconceptions about how HIV is transmitted, many parents reported avoiding common physical interactions with their children, such as hugging or kissing.
- During in-depth interviews with a subset of the HCSUS sample, many parents expressed reluctance to disclose their HIV, fearing that their children would experience discrimination.
- In many cases, children did not remain in their parents' custody, and few unmarried parents had prepared legal guardianship plans.
Because improved treatments have extended the life expectancy of HIV-positive people, the number of children with an HIV-infected parent is expected to grow. This trend adds to the urgency of helping parents and their children cope with the condition. The researchers point to several possible interventions: clinician guidance for parents in deciding whether, when, and how to disclose their infection to their children; counseling or referrals from pediatricians or other caretakers to help parents with child custody issues and guardianship planning; support groups for children of HIV-infected parents to reduce their isolation and enable them to discuss their situation with similar peers and families; and media campaigns to address persistent misconceptions about how HIV is transmitted.
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RESEARCHER PROFILE
Mark Friedberg
Mark Friedberg, MD, MPP is an Associate Natural Scientist at RAND and board-certified internist. His research focuses on the quality of care delivered by primary care practices and large physician groups. In a 2009 paper published in Annals of Internal Medicine, Dr. Friedberg and colleagues were among the first to demonstrate an association between the use of advanced electronic health records and higher quality of care. He has also investigated the responses of provider organizations to the public reporting of patient satisfaction ratings. He received his medical degree from Harvard Medical School and completed his residency in primary care internal medicine at Brigham and Women's Hospital in Boston, Massachusetts. His clinical work has included ambulatory primary care and hospital-based internal medicine.
Read more about Dr. Friedberg »
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