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Abstract
The objective of this study was to determine the strengths and limitations of using structured electronic health records (EHR) to identify and manage cardiometabolic (CM) health gaps. We used medication adherence measures derived from dispense data to attribute related therapeutic care gaps (i.e., no action to close health gaps) to patient- (i.e., failure to retrieve medication or low adherence) or clinician-related (i.e., failure to initiate/titrate medication) behavior. We illustrated how such data can be used to manage health and care gaps for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and HbA1c for 240,582 Sutter Health primary care patients. Prevalence of health gaps was 44% for patients with hypertension, 33% with hyperlipidemia, and 57% with diabetes. Failure to retrieve medication was common; this patient-related care gap was highly associated with health gaps (odds ratios (OR): 1.23–1.76). Clinician-related therapeutic care gaps were common (16% for hypertension, and 40% and 27% for hyperlipidemia and diabetes, respectively), and strongly related to health gaps for hyperlipidemia (OR = 5.8; 95% CI: 5.6–6.0) and diabetes (OR = 5.7; 95% CI: 5.4–6.0). Additionally, a substantial minority of care gaps (9% to 21%) were uncertain, meaning we lacked evidence to attribute the gap to either patients or clinicians, hindering efforts to close the gaps.
Highlights
Cardiometabolic (CM) health is a dominant focus of secondary prevention management in primary care [1,2] The persistence of elevated CM clinical measures (e.g., elevated blood pressure, HbA1c, or low-density lipoprotein cholesterol (LDL-C)), denoted as health gaps, and related risk mediators substantially increase the risk of preventable morbidity and mortality [3,4,5,6,7]
This study focused on therapeutic care gaps that are related to medication orders and adherence
For a significant minority of patients, the study results reveal that the use of structured electronic health records (EHR) data alone is not sufficient to determine whether the patient, clinician, or both are responsible for a therapeutic care gap
Summary
Cardiometabolic (CM) health is a dominant focus of secondary prevention management in primary care [1,2] The persistence of elevated CM clinical measures (e.g., elevated blood pressure, HbA1c, or low-density lipoprotein cholesterol (LDL-C)), denoted as health gaps, and related risk mediators substantially increase the risk of preventable morbidity and mortality [3,4,5,6,7]. A health gap is defined as a clinical parameter that is outside of the optimal range as defined by clinical practice guidelines (CPG). Care gaps are defined as present if an action is not taken to close the health gap. Care gaps can span a range of issues. This study focused on therapeutic care gaps that are related to medication orders and adherence (referred to as “care gaps”). Little is known about the extent to which health gaps are attributed to patient- or to provider-related care gaps
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