Use of electronic health record data to evaluate overuse of cervical cancer screening
Use of electronic health record data to evaluate overuse of cervical cancer screening
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DOI：
10.1136/amiajnl-2011-000536
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发表时间：
2012-06-01
影响因子：
6.4
通讯作者：
Baker, David W.
中科院分区：
文献类型：
--
作者：
Mathias, Jason S.;Gossett, Dana;Baker, David W.
背景国家组织历来注重增加对有效服务的使用，现在正试图识别和阻止使用低价值服务。电子健康记录(EHR)可以用来衡量低价值服务的使用情况，但很少有研究对此进行检验。这项研究的目的是：(1)确定EHR数据是否可以用来确定有资格延长巴氏试验间隔的妇女；(2)确定这些妇女比建议更早接受巴氏试验的比例；以及(3)评估这些低值巴氏试验的后果。方法电子查询EHR数据，确定30-65岁的妇女是宫颈癌的低风险者，因此有资格延长巴氏试验间隔3年(根据专业协会指南)。手工图评审评估查询准确性。对低值巴氏试验(即早于推荐的巴氏试验)的使用进行了测量，并确定了低值巴氏试验(即因低值巴氏试验而进行的镜检查)的不良后果。三分之二(1120/1705)的低风险妇女比推荐的时间更早地接受了巴氏试验，21人因此而进行了镜检查。结论对EHR数据的二次分析可以准确地衡量在低风险宫颈癌妇女中比建议更早进行巴氏检测等低价值服务的使用情况。类似地应用我们的方法可以促进同时提高质量和降低成本的努力，使美国医疗体系的价值最大化。
Background National organizations historically focused on increasing use of effective services are now attempting to identify and discourage use of low-value services. Electronic health records (EHRs) could be used to measure use of low-value services, but few studies have examined this. The aim of the study was to: (1) determine if EHR data can be used to identify women eligible for an extended Pap testing interval; (2) determine the proportion of these women who received a Pap test sooner than recommended; and (3) assess the consequences of these low-value Pap tests.Methods Electronic query of EHR data identified women aged 30-65 years old who were at low-risk of cervical cancer and therefore eligible for an extended Pap testing interval of 3 years (as per professional society guidelines). Manual chart review assessed query accuracy. The use of low-value Pap tests (ie, those performed sooner than recommended) was measured, and adverse consequences of low-value Pap tests (ie, colposcopies performed as a result of low-value Pap tests) were identified.Results Manual chart review confirmed query accuracy. Two-thirds (1120/1705) of low-risk women received a Pap test sooner than recommended, and 21 colposcopies were performed as a result of this low-value Pap testing.Conclusion Secondary analysis of EHR data can accurately measure the use of low-value services such as Pap testing performed sooner than recommended in women at low risk of cervical cancer. Similar application of our methodology could facilitate efforts to simultaneously improve quality and decrease costs, maximizing value in the US healthcare system.