Evaluating electronic health record data for use in diabetes quality reporting

描述（由申请人提供）：电子健康记录（EHR）系统和绩效付费（P4P）计划的采用率一直在增加，现在这两项创新已经合并，因为医疗保险和医疗补助服务中心（CMS）已经开始允许使用EHR数据来衡量其P4P措施的质量1,11,12,23,24虽然文献存在使用索赔和注册数据的P4P计划的挑战，很少有指导如何使用电子病历数据的质量报告。2-8很少有研究探索使用电子病历数据识别目标人群的有效性，或专门研究使用电子病历数据如何影响质量测量。5-8此外，关于EHR数据的准确性和一致性的信息很少，特别是医生如何使用EHR数据存储有关患者诊断的信息。9-10尽管缺乏信息，P4P项目正在扩大他们对电子病历数据的使用这是一个特别值得关注的问题，因为P4P计划被医生认为是不准确的，最终可能会损害P4P计划的可信度，而P4P计划实际上提高了病人的护理质量。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。我们计划通过将这些EHR方法与金标准手工病历审查进行比较，来评估使用EHR数据的不同方法（即EHR数据元素的不同组合）识别糖尿病患者的有效性。然后，我们将确定使用EHR数据的不同方法如何影响质量测量，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，了解医生如何在电子病历中记录诊断，以及他们记录行为的动机，从而更好地了解电子病历数据的可靠性。研究结果将为如何最好地利用现有EHR数据监测医疗保健质量提供指导（目前还没有）。

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.