Development of the American College of Rheumatology's Rheumatoid Arthritis Electronic Clinical Quality Measures
Development of the American College of Rheumatology's Rheumatoid Arthritis Electronic Clinical Quality Measures
复制标题
DOI：
10.1002/acr.22984
复制
发表时间：
2016-11-01
影响因子：
4.7
通讯作者：
Newman, Eric
中科院分区：
文献类型：
--
作者：
Yazdany, Jinoos;Robbins, Mark;Newman, Eric
电子临床质量测量（eCQM）依赖于计算机算法从电子健康记录（EHR）中提取数据。代表美国流变学学院（ACR），我们试图开发和测试eCQMs类风湿性关节炎（RA）。MethodsDrawing从发表的ACR指南，一个工作组制定了候选RA过程的措施，并随后通过跨学科小组的医疗保健利益相关者评估表面效度。随后是公众评论期。使用质量数据模型以电子方式指定通过这些审查级别的措施，该模型为通过EHR获得的数据元素（类别，数据类型和值集）提供标准命名法。对于每个eCQM，使用不同EHR系统的3个临床站点测试了措施的科学可行性和有效性。适当的问责措施，提出了national endorsement.ResultsExpert面板的有效性评级高的所有措施（中位数8-9 9）。健康系统在eCQM方面的表现为：RA疾病活动性评估为53.6%，功能状态评估为69.1%，疾病缓解抗风湿药物（DMARD）使用为93.1%，结核病筛查为72.8%。Kappa统计，评估是否eCQM有效捕获的数据从手动EHR图表审查，表现出中度到实质性协议（0.54功能状态评估，0.73结核病筛查，0.84疾病活动，和0.85 DMARD使用）。这些措施的实施和进一步完善正在ACR的注册表中进行，即流变学信息学有效性系统（RISE）。
ObjectiveElectronic clinical quality measures (eCQMs) rely on computer algorithms to extract data from electronic health records (EHRs). On behalf of the American College of Rheumatology (ACR), we sought to develop and test eCQMs for rheumatoid arthritis (RA).MethodsDrawing from published ACR guidelines, a working group developed candidate RA process measures and subsequently assessed face validity through an interdisciplinary panel of health care stakeholders. A public comment period followed. Measures that passed these levels of review were electronically specified using the quality data model, which provides standard nomenclature for data elements (category, datatype, and value sets) obtained through an EHR. For each eCQM, 3 clinical sites using different EHR systems tested the scientific feasibility and validity of measures. Measures appropriate for accountability were presented for national endorsement.ResultsExpert panel validity ratings were high for all measures (median 8-9 of 9). Health system performance on the eCQMs was 53.6% for RA disease activity assessment, 69.1% for functional status assessment, 93.1% for disease-modifying antirheumatic drug (DMARD) use, and 72.8% for tuberculosis screening. Kappa statistics, which evaluated whether the eCQM validly captured data obtained from manual EHR chart review, demonstrated moderate to substantial agreement (0.54 for functional status assessment, 0.73 for tuberculosis screening, 0.84 for disease activity, and 0.85 for DMARD use).ConclusionFour eCQMs for RA have achieved national endorsement and are recommended for use in federal quality reporting programs. Implementation and further refinement of these measures is ongoing in the ACR's registry, the Rheumatology Informatics System for Effectiveness (RISE).