Adoption of Order Entry with Decision Support for Chronic Care by Physician Organizations

From Clinfowiki
Jump to: navigation, search

Adoption of Order Entry with Decision Support for Chronic Care by Physician Organizations Jodi S. Simon, DrPH, Thomas G. Rundall, PhD and Stephen M. Shortell, PhD University of California, Berkeley, School of Public Health, Berkeley, CA.

The authors presented the question that “little is known about which IT components are commonly used or how they are incorporated into practice”. Their research focused on the compliance with chronic disease guidelines in an ambulatory care setting. They present and discuss a conceptual framework “that incorporates both organizational and environmental factors as predictors of adoption of order entry with decision support in physician organizations.” The factors they considered were: size, age of the organization, number of clinic locations, type of ownership, extent of managed care in the local market, urban-rural community, and presence of external incentives for improving quality.

The authors explored physician organizations’ adoption of chronic care guidelines in order entry systems and explored the organizational and market-related factors associated with this adoption. They conducted a quantitative nationwide survey of all primary care medical groups in the United States with 20 or more physicians; data were collected on 1,104 physician organizations, representing a 70% response rate. “Order entry with decision support for chronic care” was measured as the presence of an asthma, diabetes, or congestive heart failure guideline in a physician organization’s order entry system. Organizational attributes that were measured were; size; age of the organization; number of clinic locations; type of ownership; health maintenance organization market penetration; urban/rural location; and presence of external incentives to improve quality of care. External incentives were measured by: patient satisfaction; results of clinical quality improvement projects, outcomes data for selected conditions and HEDIS measures. The authors note that only 27% of organizations reported access to order entry with decision support for chronic disease care. External incentives for quality are the only factor significantly associated with adoption of these tools. Organizations experiencing greater external incentives for quality are more likely to adopt order entry with decision support. The authors conclude that because external incentives are strong drivers of adoption, policies requiring reporting of chronic care measurements and rewarding improvement as well as financial incentives for use of specific information technology tools are likely to accelerate adoption of order entry with decision support. The article did include any discussion of their methodological limitations or any potential reporting biases of the participating practices. Limitations included: data used were from 2000-2001; only physician organizations with at least 20 members were included; and the study did not explore the extent of utilization of the IT tool within the practice. The study raised questions about the extent that financial incentives could influence the use and adoption guidelines embedded within order entry systems for chronic disease care and treatment.MB