Using IT to Improve the Quality of CVD Prevention & Management

描述（由申请人提供）：电子病历（EMR）提供了分析总体医疗护理经验的机会，以确定哪些有效，哪些无效，以识别或多或少有效的护理模式，并定义各种护理方法的相对短期和长期成本以及成本效益。本研究将在大型医疗保健系统中使用EMR：1）识别关键CVD预防和疾病管理服务提供中的实践差异; 2）将实践差异与临床实践中患者4-5年的病态和死亡结局以及医疗保健利用和成本随时间的变化联系起来;以及3）向管理者提供关于实践、卫生保健团队和系统水平上的指南遵守如何与病态和死亡事件以及护理成本相关的反馈。使用电子病历，我们将观察所有的医疗保健利用和诊断之间的一个大型综合保健系统的成人健康计划成员队列中，至少有两年的连续计划成员之前，2005年1月1日。观察将持续到2008年年中，提供每个人4-5年（2003-2008年）的纵向数据。使用人-时间的方法，评估坚持预防和选定的心血管疾病管理指南，我们将描述在实践水平的变化，在心血管疾病的预防和预防性管理的高血压，高脂血症，糖尿病，充血性心力衰竭，和过去的心肌梗死患者。我们将把这些变化与随访期间的发病率、死亡率和卫生保健费用联系起来。估计样本为118，000人，在五年的随访中应产生超过12，000起重大CVD事件。 无糖尿病、高血压、高脂血症和既往CVD的患者将单独检查 预防性服务。那些先前有CVD和相关诊断的人将接受预防和管理指南依从性的检查。这些数据将阐明循证指南依从性和结局之间的关系。然后将向管理人员提供这一信息，以确定其对保健进程和政策的影响。

DESCRIPTION (Provided by the Applicant): Electronic medical records (EMR) offer the opportunity to analyze total medical care experience to determine what works and what does not, to identify patterns of care that are more or less effective, and to define the relative short-term and long-term costs and cost effectiveness of various approaches to care. This study will use EMRs in a large health-care system to: 1) identify practice variations in delivery of key CVD preventive and disease management services; 2) relate practice variation to morbid and mortal outcomes over 4-5 years among patients in the clinical practices, and also to variations over time in utilization and costs of medical care; and 3) provide feedback to managers on how guidelines adherence at the practice, health-care team, and system levels relates to morbid and mortal events, and to costs of care. Using the EMR, we will observe all health care utilization and diagnoses among a cohort of adult health plan members of a large integrated care system with at least two years of continuous plan membership prior to January 1, 2005. Observation will continue through mid-2008, providing 4-5 years (2003-2008) of longitudinal data on each individual. Using a person-time methodology that evaluates adherence to prevention and selected CVD management guidelines, we will describe variations at the practice level in CVD prevention and preventive management of patients with hypertension, hyperlipidemia, diabetes, congestive heart failure, and past myocardial infarction. We will relate those variations to morbidity, mortality, and health-care costs over the follow-up period. The estimated sample of 118,000 individuals should produce more than 12,000 major CVD events over the five years of follow-up. Patients without diabetes, hypertension, hyperlipidemia, and prior CVD will be examined separately for preventive services only. Those with prior CVD and related diagnoses will be examined for both preventive and management guidelines adherence. These data will clarify the relationships between evidence-based guidelines adherence and outcomes. That information will then be provided to managers in order to determine its impact on health-care processes and policies.