Electronic health record and primary care physician self-reported quality of care: a multilevel study in China

Figures & data

Table 1. Characteristics of physician respondents and CHCs.

Characteristics	n	%
Physicia* characteristics (N = 224)
Age
<35	116	51.8
35–44	75	33.5
45–54	31	13.8
>54	2	0.9
Gender
Male	90	40.2
Education level
Master or above	36	16.1
Tenured position
Yes	170	75.9
CHC characteristics (N = 38)
Management type
Government	23	60.5
Public hospital	15	39.5
Government accreditation
Yes	22	57.9
Medical equipment number
<5	8	21.1
5–10	12	31.6
11–30	5	13.2
>30	13	34.2
Number of CHC staff
≤35	13	34.2
36–55	7	18.4
56–100	7	18.4
>100	11	29.0

Note: *Physician refers to the 224 primary care physicians in the 38 CHCs. CHC: community health centre.

Table 2. Association of EHR feature availability with care quality as shown by t-test of difference in crude care quality means between CHCs with vs. without EHR features.

EHR features	Availability	Clinical quality	P value	Preventive quality	P value
1. Share records online with providers outside the practice	Yes (n = 17)	4.28	0.002^†	3.71	0.041*
	No (n = 21)	3.88		3.47
2. Access records online by provider	Yes (n = 24)	4.08	0.950	3.61	0.745
	No (n = 14)	4.08		3.57
3. Access records online by the patient	Yes (n = 14)	4.21	0.006^†	3.59	0.867
	No (n = 24)	3.86		3.57
4. Access test results online by provider	Yes (n = 14)	4.11	0.581	3.61	0.648
	No (n = 24)	4.04		3.55
5. Alert provider of potential prescription problems	Yes (n = 15)	4.18	0.043*	3.62	0.541
	No (n = 23)	3.92		3.54
6. Alert provider to provide patients with test results	Yes (n = 20)	4.18	0.144	3.59	0.992
	No (n = 18)	3.99		3.59
7. Send the patient reminders for care	Yes (n = 21)	4.30	0.006^†	3.68	0.208
	No (n = 17)	3.94		3.53
8. List patients by diagnosis or health risk	Yes (n = 22)	4.30	0.010*	3.68	0.221
	No (n = 16)	3.96		3.53
9. List patients due for tests or preventive care	Yes (n = 21)	4.24	0.055	3.70	0.147
	No (n = 17)	3.99		3.52
10. List of all medications taken by patients	Yes (n = 16)	4.10	0.775	3.63	0.424
	No (n = 22)	4.06		3.54

Note: The Quality of Care Likert scale ranges from 1 representing worst to 5 representing best. The Quality of Care metric in this table is the mean value of the physician self-reported quality of care that they provide. EHR: electronic health record. CHC: community health centre.

*p < 0.05

^†p < 0.01

Table 3. Strength of association between ten EHR features and quality of care.

EHR features	Clinical quality		Preventive quality
	β (SE)	P	β (SE)	P
1. Share records online with providers outside the practice	0.276 (0.135)	0.040*	0.032 (0.136)	0.816
2. Access records online by provider	0.431 (0.280)	0.123	− 0.123 (0.273)	0.652
3. Access records online by the patient	0.325 (0.160)	0.043*	− 0.021 (0.161)	0.896
4. Access test results online by provider	− 0.092 (0.144)	0.522	0.007 (0.142)	0.963
5. Alert provider of potential prescription problems	0.353 (0.169)	0.037*	0.191 (0.170)	0.262
6. Alert provider to provide patients with test results	0.104 (0.143)	0.469	− 0.053 (0.141)	0.708
7. Send the patient reminders for care	0.419 (0.142)	0.003^†	0.028 (0.144)	0.844
8. List patients by diagnosis or health risk	0.282 (0.134)	0.035*	0.073 (0.135)	0.586
9. List patients due for tests or preventive care	0.190 (0.137)	0.165	0.033 (0.137)	0.807
10. List of all medications taken by patients	0.231 (0.150)	0.123	0.119 (0.149)	0.424

Note: EHR: electronic health record. Two models were built for each of the ten EHR features, one for clinical quality as dependent variable, and the other for preventive quality as dependent variable. For each model, control variables included age, gender, education, tenured position at physician level – level 1, management type, government accreditation, medical equipment number, CHC staff number, and per cent of health professionals at CHC level – level 2.

*p < 0.05

^†p < 0.01

Table 4. Strength of association between total EHR feature score and quality of care.

Parameter	Clinical quality		Preventive quality
	β (SE)	P	β (SE)	P
Intercept	2.763 (0.756)	<0.001^‡	3.812 (0.754)	<0.001^‡
Physician^¶ characteristics – level 1
Age	0.027 (0.008)	0.001^‡	0.018 (0.007)	0.015*
Gender (ref. = female)
Male	0.154 (0.123)	0.210	−0.073 (0.112)	0.518
Education level (ref. = college or below)
Master or above	−0.021 (0.178)	0.906	−0.019 (0.166)	0.911
Tenured position (ref. = no)
Yes	−0.118 (0.173)	0.493	−0.031 (0.157)	0.843
CHC characteristics – level 2
Management type (ref. = government)
Public hospital	−0.144 (0.194)	0.458	0.073 (0.199)	0.712
Government accreditation (ref. = no)
Yes	−0.168 (0.140)	0.229	−0.289 (0.145)	0.045*
Medical equipment number (ref. <5)
5–10	0.183 (0.193)	0.345	0.024 (0.194)	0.900
11–30	0.346 (0.234)	0.139	−0.052 (0.238)	0.827
>30	0.521 (0.252)	0.039*	0.457 (0.258)	0.077
Number of CHC staff (ref. ≤35)
36–55	−0.470 (0.194)	0.016*	−0.536 (0.199)	0.007^†
56–100	−0.373 (0.217)	0.086	−0.583 (0.226)	0.010^†
>100	−0.601 (0.210)	0.004^†	−0.590 (0.220)	0.007^†
Per cent of CHC staff who are health professionals	0.520 (0.634)	0.413	−0.590 (0.648)	0.363
Total EHR feature score	0.633 (0.246)	0.010*	0.103 (0.253)	0.683

Note: These quality scores were assessed on a scale of 1–5 (5 being best) by the 224 physician survey respondents who work at the respective CHCs. EHR: electronic health record.

*p < 0.05.

^†p < 0.01.

^‡p < 0.001.

^¶Physician refers to the 224 primary care physicians serving the 38 CHCs.