Neurocritical Care Performance Measures Derived from Electronic Health Record Data are Feasible and Reveal Site-Specific Variation: A CHoRUS Pilot Project.
Neurocritical Care Performance Measures Derived from Electronic Health Record Data are Feasible and Reveal Site-Specific Variation: A CHoRUS Pilot Project.
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DOI：
10.1007/s12028-022-01497-0
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发表时间：
2022-08
影响因子：
3.5
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我们评估了最近提出的神经重症监护临床表现测量（神经重症监护协会）和从电子健康记录（EHR）流程图数据中提取的创伤性脑损伤质量指标（CENTER-TBI）的可行性和可区分性。在公平人工智能合作标准联合标准 (CHORUS) 联盟的 3 个中心，我们检查了超过 24 小时 (03/2015-02/2020) 的连续神经重症监护入院情况，并评估了五种临床表现测量和质量指标的可行性、可区分性和特定地点的变化：1) 需要时 24 小时内进行 ICP 监测 (ICPM)，2) 24 小时内启动时的 ICPM 潜伏期小时，3) 护士记录的神经系统评估的频率，4) 24 小时内启动间歇性气动加压装置 (IPCd)，以及 5) IPCd 应用的潜伏期。我们还探讨了 IPCd 启动延迟与 ICD-10 记录的静脉血栓栓塞 (VTE) 之间的关联。 Median [IQR] statistics are reported. Kruskal-Wallis 检验测量了中心间的差异，并报告了 Dunn 统计数据的中心间差异。 14,985 admissions met inclusion criteria. 1,514 人 (10.1%) 记录了 ICPM，14,635 人 (91.1%) 记录了神经系统评估，14,175 人 (88.5%) 记录了 IPCd 应用。 ICPM 在 24 小时内开始，持续 1,267 例 (83.7%)，位点 1-3 之间的位点特异性潜伏期差异分别为（0.54 小时 [2.82]、0.58 小时 [1.68] 和 2.36 小时 [4.60]；p<0.001）。护士记录的神经系统评估的频率也因地点而异（17.4 次/天 [5.97]、8.4 次/天 [3.12] 和 15.3 次/天 [8.34]；p < 0.001）和每日（白天 6.90 次/天 vs. 夜间 5.67 次/天，p < 0.001）。 24 小时内，12,863 名 (90.7%) 符合临床资格的患者接受了 IPCd（不包括那些有限制性损伤的 EHR 文件、主动记录为行走或拒绝预防的患者）。院内 VTE 因部位而异（1.23%、1.55% 和 5.18%；p<0.001），并且与 IPCd 潜伏期增加相关（总体而言，1.02 小时 [10.4] 与 0.97 小时 [5.98]，p = 0.479；部位 1：2.25 小时 [10.27] 与 1.82 小时[7.39]，p=0.713；位点 2：1.38h [5.90] 对比 0.80h [0.53]，p=0.216；位点 3：0.40h [16.3] 对比 0.35h [11.5]，p=0.036）。基于 EHR 的神经重症监护绩效测量报告是可行的，并且证明了特定地点的差异。未来的工作应该检查绩效或文档是否驱动这些衡量标准，哪些结果与绩效相关，以及 EHR 衍生的绩效衡量标准和质量指标是否可以修改。
We evaluated the feasibility and discriminability of recently proposed Clinical Performance Measures for Neurocritical Care (Neurocritical Care Society) and Quality Indicators for Traumatic Brain Injury (CENTER-TBI) extracted from electronic health record (EHR) flowsheet data. At 3 centers within the Collaborative Hospital Repository Uniting Standards for Equitable AI (CHoRUS) consortium, we examined consecutive neurocritical care admissions exceeding 24 hours (03/2015–02/2020), and evaluated the feasibility, discriminability, and site-specific variation of five clinical performance measures and quality indicators: 1) ICP monitoring (ICPM) within 24 hours when indicated, 2) ICPM latency when initiated within 24 hours, 3) frequency of nurse-documented neurologic assessments, 4) intermittent pneumatic compression device (IPCd) initiation within 24 hours, and 5) latency to IPCd application. We additionally explored associations between delayed IPCd initiation and ICD-10-documented venous thromboembolism (VTE). Median [IQR] statistics are reported. Kruskal-Wallis tests were measured for differences across centers, and Dunn statistics were reported for between-center differences. 14,985 admissions met inclusion criteria. ICPM was documented in 1,514 (10.1%), neurologic assessments in 14,635 (91.1%), and IPCd application in 14,175 (88.5%). ICPM began within 24 hours for 1,267 (83.7%) with site-specific latency differences among sites 1–3, respectively, (0.54h [2.82], 0.58h [1.68], and 2.36h [4.60]; p<0.001). The frequency of nurse-documented neurologic assessments also varied by site (17.4/day [5.97], 8.4/day [3.12], and 15.3/day [8.34]; p<0.001) and diurnally (6.90/day during daytime hours vs. 5.67/day at night, p < 0.001). IPCd were applied within 24 hours for 12,863 (90.7%) of patients meeting clinical eligibility (excluding those with EHR documentation of limiting injuries, actively documented as ambulating, or refusing prophylaxis). In-hospital VTE varied by site (1.23%, 1.55%, and 5.18%; p<0.001) and was associated with increased IPCd latency (Overall. 1.02h [10.4] vs. 0.97h [5.98], p = 0.479; Site 1: 2.25h [10.27] vs. 1.82h [7.39], p=0.713; Site 2: 1.38h [5.90] vs. 0.80h [0.53], p=0.216; Site 3: 0.40h [16.3] vs. 0.35h [11.5], p=0.036). EHR-derived reporting of neurocritical care performance measures is feasible and demonstrates site-specific variation. Future efforts should examine whether performance or documentation drives these measures, what outcomes are associated with performance, and whether EHR-derived measures of performance measures and quality indicators are modifiable.
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DOI：
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DOI：
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通讯作者：
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