Can the use of Electronic Health Records in General Practice reduce hospitalizations for diabetes patients?

Evidence from a natural experiment

Line Planck Kongstad, Giovanni Mellace, Kim Rose Olsen

Research output: Working paperResearch

Abstract

Disease management programmes (DMP) in the general practice sector are increasingly used to improve health of chronically ill patients, reduce hospitalizations and thereby costs. The aim of this paper is to estimate the causal effects of the enrolment of general practices (GP) in a DMP based on Electronic Health Records (EHR) on diabetes patients total hospitalizations, diabetes related hospitalizations and hospitalizations with diabetes and cardiovascular related Ambulatory Care Sentive Conditions (ACSC). We use a rich nationwide panel dataset (2004-2013) with information of stepwise enrolment of GPs in the EHR program. As a control group we use GPs who never enrolled. Following the recent literature on causal inference with panel data, we use a standard propensity score matching estimator where we also match on pre-treatment outcomes. This allows controlling for all the unobservable confounders which were already present in the pre-treatment outcomes. Alternative, we use a difference in difference as well as a parametric model with a continuous treatment specification and find similar results. Our results show that enrolment in EHR reduced diabetes patients’ risk of hospitalizations by more than 10%. The results are comparable with studies on EHR programs from California and the magnitudes of the effects are comparable to DMPs including both EHR and financial incentives.
Original languageEnglish
PublisherDepartment of Economics, University of York
Number of pages42
Publication statusPublished - 2016
SeriesHealth, Econometrics and Data Group (HEDG) Working Papers
Number25
Volume16

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General practice
Electronic health record
Natural experiment
Diabetes
Hospitalization
Enrollment
Treatment outcome
Pretreatment
Disease management
Ambulatory care
Financial incentives
Propensity score matching
Difference-in-differences
Parametric model
Costs
Matching estimators
Panel data
Causal effect
Health
Causal inference

Cite this

Kongstad, L. P., Mellace, G., & Rose Olsen, K. (2016). Can the use of Electronic Health Records in General Practice reduce hospitalizations for diabetes patients? Evidence from a natural experiment. Department of Economics, University of York. Health, Econometrics and Data Group (HEDG) Working Papers, No. 25, Vol.. 16
Kongstad, Line Planck ; Mellace, Giovanni ; Rose Olsen, Kim. / Can the use of Electronic Health Records in General Practice reduce hospitalizations for diabetes patients? Evidence from a natural experiment. Department of Economics, University of York, 2016. (Health, Econometrics and Data Group (HEDG) Working Papers; No. 25, Vol. 16).
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