Evaluating electronic health record data for use in diabetes quality reporting

评估用于糖尿病质量报告的电子健康记录数据

• 批准号: 8069428
• 负责人: Annemarie Gregory Hirsch
• 金额: $ 3.79万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8069428
• 关键词: Evaluating; electronic; health; record; data

DESCRIPTION (provided by applicant): Adoption rates of electronic health record (EHR) systems and pay-for-performance (P4P) programs have been increasing and now these two innovations have merged, as the Center for Medicare and Medicaid Services (CMS) has started to permit the use of EHR data for measuring quality in their P4P measures.1,11,12,23,24 While literature exists on the challenges of using claims and registry data for P4P programs, there is little guidance on how to use EHR data for quality reporting. 2-8 Few studies have explored the validity of using EHR data to identify a target population or studied specifically how using EHR data can impact quality measures.5-8 In addition, there is little information on the accuracy and consistency of EHR data, specifically how physicians use the EHR data to store information about patient diagnoses.9-10 Despite this lack of information, P4P programs are expanding their use of EHR data.1 This is a particular concern given that P4P programs that are perceived to be inaccurate by physicians may ultimately damage the credibility of P4P programs that actually improve the quality of patient care. Our study proposes to evaluate the validity of using EHR data in P4P measures, specifically focusing on quality measures in diabetes, one of the conditions for which CMS permits the use of EHR data. We plan to evaluate the validity of different approaches to using EHR data (i.e., different combinations of EHR data elements) in identifying patients with diabetes by comparing these EHR approaches to a gold standard manual medical record review. We will then determine how different approaches to using EHR data impact quality measures, specifically how these approaches impact the proportion of patients who meet quality standards. Finally, we will gain a better understanding of the reliability of EHR data by learning how physicians document diagnoses in the EHR and what motivates their documentation behaviors, through one-on-one interviews with primary care physicians. The findings will provide guidance, currently unavailable, as to how to best leverage existing EHR data for monitoring healthcare quality. PUBLIC HEALTH RELEVANCE: Administrators of pay-for-performance programs (P4P) that have traditionally used claims data for quality measures have started to permit the use of data from electronic health records (EHRs). However, there is very little understanding about the methods of using EHR data for quality purposes, and inaccurate or biased quality measures can seriously undermine the credibility of valuable quality improvement initiatives. This project will evaluate the validity of using EHR data for quality measures, providing critical information to administrators of quality improvement program as they move towards using EHR data.

描述(由申请人提供)：电子健康记录(EHR)系统和按绩效付费(P4P)计划的采用率一直在增加，现在这两项创新已经合并，因为联邦医疗保险和医疗补助服务中心(CMS)已开始允许在其P4P措施中使用EHR数据来衡量质量。1、11、12、23、24虽然有文献说明使用P4P计划的索赔和注册数据的挑战，但关于如何使用EHR数据进行质量报告的指导很少。2-8很少有研究探索使用电子健康记录数据来确定目标人群的有效性，或具体研究使用电子健康记录数据如何影响质量衡量。5-8此外，关于电子健康记录数据的准确性和一致性的信息很少，特别是医生如何使用电子健康记录数据来存储有关患者诊断的信息。9-10尽管缺乏信息，但P4P计划正在扩大其对电子健康记录数据的使用1这是一个特别令人担忧的问题，因为医生认为不准确的P4P计划最终可能会损害实际改善患者护理质量的P4P计划的可信度。我们的研究建议评估在P4P测量中使用EHR数据的有效性，特别是关注糖尿病的质量测量，这是CMS允许使用EHR数据的条件之一。我们计划评估使用电子病历数据(即电子病历数据元素的不同组合)的不同方法在识别糖尿病患者方面的有效性，方法是将这些电子病历方法与黄金标准的手动病历审查进行比较。然后，我们将确定使用电子病历数据的不同方法如何影响质量衡量，特别是这些方法如何影响符合质量标准的患者比例。最后，我们将通过与初级保健医生的一对一访谈，了解医生如何将诊断记录在EHR中，以及是什么促使他们记录诊断行为，从而更好地了解EHR数据的可靠性。这些发现将为如何最好地利用现有的电子健康记录数据来监测医疗质量提供指导，目前还无法获得。 公共卫生相关性：传统上使用索赔数据进行质量衡量的按绩效付费计划(P4P)的管理者已经开始允许使用来自电子健康记录(EHR)的数据。然而，对于将EHR数据用于质量目的的方法了解很少，不准确或有偏见的质量措施可能会严重破坏有价值的质量改进倡议的可信度。该项目将评估使用电子健康记录数据进行质量测量的有效性，为质量改进计划的管理者提供关键信息，帮助他们转向使用电子健康记录数据。