Leveraging electronic health records to develop measurements for processes of care

Objectives To assess the reliability of data in electronic health records (EHRs) for measuring processes of care among primary care physicians (PCPs) and examine the relationship between these measures and clinical outcomes. Data Sources/Study Setting EHR data from 15,370 patients with diabetes, 49,561 with hypertension, in a group practice serving four Northern California counties. Study Design/Methods Exploratory factor analysis (EFA) and multilevel analyses of the relationships between processes of care variables and factor scales with control of hemoglobin A1c, blood pressure (BP), and low density lipoprotein (LDL) among patients with diabetes and BP among patients with hypertension. Principal Findings Volume of e-messages, number of days to the third-next-available appointment, and team communication emerged as reliable factors of PCP processes of care in EFA (Cronbach's alpha = 0.73, 0.62, and 0.91). Volume of e-messages was associated with higher odds of LDL control (≤100) (OR = 1.13, p <.05) among patients with diabetes. Frequent in-person visits were associated with better BP (OR = 1.02, p <.01) and LDL control (OR = 1.01, p <.01) among patients with diabetes, and better BP control (OR = 1.04, p <.01) among patients with hypertension. Conclusions The EHR offers process of care measures which can augment patient-reported measures of patient-centeredness. Two of them are significantly associated with clinical outcomes. Future research should examine their association with additional outcomes.