Electronic Health Records as Valuable Data Sources in the Health Care Quality Improvement Process

Wikström, Katja; Toivakka, Maija; Rautiainen, Päivi; Tirkkonen, Hilkka; Repo, Teppo; Laatikainen, Tiina

doi:10.1177/2333392819852879

Cited by 11 publications

(11 citation statements)

References 16 publications

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“…Furthermore, in the HBCS, HbA1c ≥6.5% or 48 mmol/mol was used to identify type 2 diabetes. Through the combination of these methods the sensitivity is likely very high, although a few individuals with type 2 diabetes may not be identified if they missed the clinical examination and were treated only with diet in general practice (36).…”

Section: Assessment Of Type 2 Diabetesmentioning

confidence: 99%

Possible Modifiers of the Association Between Change in Weight Status From Child Through Adult Ages and Later Risk of Type 2 Diabetes

et al. 2020

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Objective: We investigated the association between changes in weight status from childhood through adulthood and subsequent type 2 diabetes risks and whether educational attainment, smoking and leisure time physical activity (LTPA) modify this association. Research design and methods: Using data from 10 Danish and Finnish cohorts including 25,283 individuals, childhood body mass index (BMI) at 7 and 12 years was categorised as normal or high using age-and sex-specific cutoffs (

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Section: Assessment Of Type 2 Diabetesmentioning

confidence: 99%

Possible Modifiers of the Association Between Change in Weight Status From Child Through Adult Ages and Later Risk of Type 2 Diabetes

et al. 2020

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“…All this increased better awareness of current situation under single management, which formed the core of regional diabetic care model. It seems that these organizational changes and overall quality improvement efforts carried out for several years in the region by a network of professionals treating patients with diabetes have improved the treatment outcomes, reduced some unnecessary follow-up visits in primary care and targeted the contacts so they are more with those who are not controlled [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…From the beginning of the year 2011, the regional EHR system has covered all health centres in North Karelia as well as the central hospital [ 19 ]. EHRs have great potential for monitoring and improving the processes and quality of diabetes care [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…This might reflect that unnecessary control visits in primary health care are cut off and specialised know-how is provided for those in need. Furthermore, the early detection of type 2 diabetes has improved in the region [19], which might have caused increased need for secondary care consultations by finding more complex cases than previously. Previous studies have shown that nurse-led care should be an integral element of the health care services offered to type 2 diabetes patients, and nurse-led interventions have been shown to improve the treatment outcomes, such as the level of HbA1c [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

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The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland

Wikström

Lamidi

Rautiainen

et al. 2021

BMC Health Serv Res

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Background The need to improve the care of people with complex care requirements has been driving the reforms integrating care processes. This study examines the effect of the integration of health services on health care usage and the processes and outcomes of care among type 2 diabetes patients. Methods Data include all type 2 diabetes patients who lived in North Karelia, Finland, between 2014 and 2018. Health care contacts and glycated haemoglobin (HbA1c) measurements were obtained from the electronic health records. Logistic, Poisson and linear models with generalised estimating equations and the Friedman test were used to study the differences between years. Results The health care usage was highest in 2017, the first year of a new organisation, and smallest in the following year. Before the new organisation, the health care usage was lowest in 2014, being slightly higher compared with 2018. Between the last two years, the mean number of contacts per person declined from 3.25 to 2.88 (-0.37, p < 0.001). The decreasing pattern seen in total health care usage was most obvious among contacts with primary health care nurses. The number of contacts increased only among specialised care nurses between the last two years. The number of HbA1c measurements was also in its lowest in 2018 but in its highest in 2015. Between the years 2014 and 2018, the difference in the mean number of contacts was − 0.05 (p = 0.011) for those not measured, -0.02 (p = 0.225) for those measured and within the target level of HbA1c, and 0.12 (p = 0.001) for those measured and not at the target level of HbA1c. Conclusions Health care integration first increased the health care usage but then brought it to a slightly lower level than before. The changes were most obvious in primary health care nurses’ appointments, and no decline was observed in secondary-level care. Even though the numbers of HbA1c measurements and the proportion measured declined, measurements increased among those with poor glycaemic control. The observed changes might reflect the better targeting and more concordant services in different service units.

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“…Compared with other international publications on changes in treatment balance over time, rates of 1.4–1.5 mmol/mol (0.12–0.14% units in HbA1c) of increase per year are reported [ 34 , 35 ]. The lower rate of increase in our studies may reflect the early detection and active treatment of T2D patients in the North Karelia region [ 36 ]. In addition, SGLT2 inhibitors became reimbursable in 2016 and the price of newer medications, such as GLP-1 analogues, has decreased over the study period increasing their use and, thus, reducing the use of insulins.…”

Section: Discussionmentioning

confidence: 99%

Impact of co-payment level increase of antidiabetic medications on glycaemic control: an interrupted time-series study among Finnish patients with type 2 diabetes

Lavikainen

Aarnio

Jalkanen

et al. 2020

BMC Health Serv Res

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Background A new special reimbursement scheme (SRS) for non-insulin medications used for treatment of hyperglycaemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The new SRS affected all community-dwelling Finnish T2D patients as all community-dwelling residents are eligible for reimbursement for prescription medications. The aim of the study was to evaluate the impact of this co-payment increase on glycaemic control among Finnish T2D patients. Methods Data on glycaemic control were collected with HbA1c measures from electronic health records from primary health care and specialized care in the North Karelia region, Finland, from patients with a confirmed T2D diagnosis in 2012 who were alive on January 1, 2017 (n = 8436). Average HbA1c levels were measured monthly 36 months before and 33 months after the policy change. Consumption of diabetes medications was measured with defined daily doses (DDDs) based on reimbursed medication purchases. Interrupted time series design analysed with segmented regression model was applied to examine the effect of the policy change on average HbA1c levels. Results Eight thousand one hundred forty-three T2D patients had at least one HbA1c measurement within 01/2014–9/2019. Mean age of the patients was 68.1 (SD 11.3) years and 53.0% were women. Average time since T2D diagnosis was 11.5 (SD 6.1) years. An estimated increase of 0.81 (95% confidence interval, CI, 0.04–1.58) mmol/mol in average HbA1c levels was detected at the time of the policy change. In subgroup analyses, strongest effects were detected among patients who used only other diabetes medications than insulin or metformin in 2016 (3.56 mmol/mol, 95% CI 2.50–4.62). Meanwhile, yearly consumption of diabetes medications decreased slightly from 618.9 (SD 487.8) DDDs/patient in 2016 to 602.9 (SD 475.6) DDDs/patient in 2017 (p = 0.048). Conclusions Simultaneously with the increase of the co-payment level, the average HbA1c level increased among T2D patients from the North Karelia region, Finland. This may be explained by the decreased consumption of diabetes medications between 2016 and 2017. Special attention should be allocated to glycaemic control of patients utilizing only other antidiabetic medications than metformin or insulin.

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Electronic Health Records as Valuable Data Sources in the Health Care Quality Improvement Process

Cited by 11 publications

References 16 publications

Possible Modifiers of the Association Between Change in Weight Status From Child Through Adult Ages and Later Risk of Type 2 Diabetes

Possible Modifiers of the Association Between Change in Weight Status From Child Through Adult Ages and Later Risk of Type 2 Diabetes

The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland

Impact of co-payment level increase of antidiabetic medications on glycaemic control: an interrupted time-series study among Finnish patients with type 2 diabetes

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