Development and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke
Development and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke
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DOI：
10.1161/circoutcomes.116.003157
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发表时间：
2017-09-01
影响因子：
6.9
通讯作者：
Arling, Greg
中科院分区：
文献类型：
--
作者：
Bravata, Dawn M.;Myers, Laura J.;Arling, Greg
背景--尽管人们对使用电子健康记录(EHR)数据来评估护理质量感兴趣，但这种数据的准确性在很大程度上是未知的。我们试图使用EHR数据开发和验证短暂性脑缺血发作和轻度缺血性卒中电子质量测量(EQM)。方法和结果-确定了在退伍军人健康管理机构(2011财年)接受护理的短暂性脑缺血发作或轻微缺血性卒中患者的随机样本。在现有质量指标的基础上，我们构建了31个EQM。图表评审是确认EQM的标准标准。为了评估EQM的合格性，我们计算了真正没有资格接受治疗的患者的比例(基于图表回顾)，以及被EHR数据正确识别为不合格的患者的比例(特异性)。为了评估关于患者是否接受治疗的分类的EQM，我们计算了实际接受治疗的患者的比例(基于图表回顾)，以及被EHR数据正确归类为合格(敏感性)的患者的比例。共纳入763例患者。关于合格性，特异性从25%(脑成像；颈动脉成像)到99%(抗凝质量)不等。关于通过率，敏感度从30%(降压级)到100%(冠状动脉风险评估；测量的国际标准化比率)不等。符合条件的特异度为70%，通过率为70%的16个EQM包括冠状动脉风险评估、国际标准化比率测量、HbA1c测量、言语病理咨询、房颤的抗凝、他汀类药物的出院、血脂管理、神经内科咨询、Holter、深静脉血栓预防、口服降糖强化、胆固醇药物强化、降压强化、抗高血压分级、颈动脉狭窄干预和酒精类药物滥用转介。结论：构建适用于短暂性脑缺血发作和轻度缺血性卒中护理的有效EQM。拥有EHR的医疗系统应该考虑使用电子数据来评估对短暂性脑缺血发作患者的护理，并补充和扩大目前专注于中风患者的质量测量计划。
Background-Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data.Methods and Results-A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified. We constructed 31 eQMs based on existing quality measures. Chart review was the criterion standard for validating the eQMs. To evaluate eQMs in terms of eligibility, we calculated the proportion of patients who were genuinely not eligible to receive a process (based on chart review) and who were correctly identified as not eligible by the EHR data (specificity). To assess eQMs about classification of whether patients received a process, we calculated the proportion of patients who actually received the process (based on chart review) and who were classified correctly by the EHR data as passing (sensitivity). Seven hundred sixty-three patients were included. About eligibility, specificity varied from 25% (brain imaging; carotid imaging) to 99% (anticoagulation quality). About pass rates, sensitivity varied from 30% (antihypertensive class) to 100% (coronary risk assessment; international normalized ratio measured). The 16 eQMs with = 70% specificity in eligibility and = 70% sensitivity in pass rates included coronary risk assessment, international normalized ratio measured, HbA1c measurement, speech language pathology consultation, anticoagulation for atrial fibrillation, discharge on statin, lipid management, neurology consultation, Holter, deep vein thrombosis prophylaxis, oral hypoglycemic intensification, cholesterol medication intensification, antihypertensive intensification, antihypertensive class, carotid stenosis intervention, and substance abuse referral for alcohol.Conclusions-It is feasible to construct valid eQMs for processes of transient ischemic attack and minor ischemic stroke care. Healthcare systems with EHRs should consider using electronic data to evaluate care for their patients with transient ischemic attack and to complement and expand quality measurement programs currently focused on patients with stroke.