ABSTRACT
BACKGROUND AND OBJECTIVES: Patients with depression most frequently present in primary care. Electronic health records (EHR) have the potential to improve depression care through improved clinical documentation and information exchange. This report provides an example of how an EHR can fail to capture important information regarding depression care. METHODS: A 6-month baseline period in 2009 was defined to identify ambulatory patients age 18 or older in the EHR with an ICD-9 coded new depression diagnosis. Data was abstracted electronically, and charts were reviewed by hand for patient demographics and to assess the clinical documentation of depression screening, diagnosis, and treatment practices among four community-based family medicine clinics. RESULTS: Electronic abstraction of baseline data identified 200 adult patients with a documented new diagnosis of depression. Review of charts by hand was required to obtain clinical documentation of screening (9% of patients), use of diagnostic tools (73%), discussion of treatment options (83%), medication treatment (71%), and follow-up characteristics (75%). CONCLUSIONS: Despite having a robust EHR, we encountered significant challenges finding documentation of depression care, which also made it difficult to track and evaluate the implementation of evidence-based treatment. Clinical documentation in the EHR needs to be simplified and standardized if data extraction and exporting processes of clinician performance data are to become efficient and routine practice.
Subject(s)
Depression , Documentation/standards , Electronic Health Records/standards , Family Practice/standards , Academic Medical Centers/organization & administration , Academic Medical Centers/standards , Adolescent , Adult , Aged , Aged, 80 and over , Depression/diagnosis , Depression/therapy , Documentation/statistics & numerical data , Electronic Health Records/organization & administration , Electronic Health Records/statistics & numerical data , Family Practice/organization & administration , Female , Humans , Male , Middle Aged , Oregon , Quality Assurance, Health Care , Young AdultABSTRACT
AIMS: To estimate the prevalence of insulin resistance (HOMA-IR) and to study its relationship with selected cardiovascular disease risk factors among Thai adults. METHODS: This cross-sectional study was comprised of 227 men and 990 women undergoing routine health check-up. The prevalence of insulin resistance was estimated using diagnostic criteria previously employed in Asian and other populations. Spearman's rank correlation coefficients were used to evaluate associations of HOMA-IR with selected cardiovascular disease risk factors. Multivariable logistic regression procedures were used to evaluate associations of hypertriglyceridemia, low HDL-Cholesterolemia, and hypertension with varying HOMA-IR values. RESULTS: Approximately 25.1% of men (HOMA-IR>or=1.56) and 21.5% of women (HOMA-IR>or=1.64) were classified as having insulin resistance. HOMA-IR values were statistically significantly and positively associated with body mass index, body fat percentage, waist circumference, and serum triglycerides. The values were inversely correlated with HDL-Cholesterol. When compared with those whose HOMA-IR values were within the lowest quartile (<0.45), men with HOMA-IR values in the highest quartile (>or=1.58) had higher risks of hypertriglyceridemia (adjusted OR=2.83), low HDL-Cholesterolemia (adjusted OR=2.79), and hypertension (adjusted OR=2.76). Similar associations were observed among women. CONCLUSION: Insulin resistance, as determined using HOMA-IR, was positively associated with selected cardiovascular disease risk factors among Thai adults.
