Enhanced Quality Measurement Event Detection: An Application to Physician Reporting.
Enhanced Quality Measurement Event Detection: An Application to Physician Reporting.
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DOI：
10.13063/2327-9214.1270
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发表时间：
2017-05-30
期刊：
影响因子：
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通讯作者：
Shah NH
中科院分区：
文献类型：
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作者：
Tamang SR;Hernandez-Boussard T;Ross EG;Gaskin G;Patel MI;Shah NH
电子健康记录（EHR）的广泛采用增加了常规收集的电子形式临床数据的可用性，可用于改进护理质量的报告。然而，电子病历中的大部分信息是非结构化的形式（例如，自由文本的临床记录），不适合自动报告。传统的方法基于结构化的诊断和账单数据，这些数据提供了对实际或相关的护理过程和患者结果的有效但不准确或不完整的摘要。为了评估实施增强的基于电子病历的医生质量测量和报告的可行性和效益，其中包括对非结构化免费文本临床记录的分析，我们进行了一项回顾性研究，比较了来自多个国家质量战略领域的10项医生质量测量的传统和增强方法。我们发现，我们的改进方法能够计算出在账单或诊断代码中无法测量的五项医生质量和绩效系统测量，并导致事件的平均精度增加了五倍以上，达到88% （95% CI: 83 - 93%）。我们的工作表明，增强的基于电子病历的质量测量可以增加事件检测，以建立基于价值的支付安排，并可以加快医生实践的质量报告，这些实践越来越多地受到手工图表审查质量报告过程的负担。
The wide-scale adoption of electronic health records (EHR)s has increased the availability of routinely collected clinical data in electronic form that can be used to improve the reporting of quality of care. However, the bulk of information in the EHR is in unstructured form (e.g., free-text clinical notes) and not amenable to automated reporting. Traditional methods are based on structured diagnostic and billing data that provide efficient, but inaccurate or incomplete summaries of actual or relevant care processes and patient outcomes. To assess the feasibility and benefit of implementing enhanced EHR- based physician quality measurement and reporting, which includes the analysis of unstructured free- text clinical notes, we conducted a retrospective study to compare traditional and enhanced approaches for reporting ten physician quality measures from multiple National Quality Strategy domains. We found that our enhanced approach enabled the calculation of five Physician Quality and Performance System measures not measureable in billing or diagnostic codes and resulted in over a five-fold increase in event at an average precision of 88 percent (95 percent CI: 83–93 percent). Our work suggests that enhanced EHR-based quality measurement can increase event detection for establishing value-based payment arrangements and can expedite quality reporting for physician practices, which are increasingly burdened by the process of manual chart review for quality reporting.