Measurement that Matters: Retooling Risk Adjusted Outcome Measures to Support Practical Data Collection through Electronic Health Records

 描述（由申请人提供）：本研究项目评估不同的电子健康记录（EHR）收集标准化，风险调整和临床相关结局指标的能力。EHR的引入有望实现强大的风险调整模型，这将使不同患者，治疗，提供者或人群之间的结果能够进行公平比较，而无需与劳动密集型数据收集相关的成本。到目前为止，从纸质格式到电子（eMeasure）格式的质量衡量标准的重组主要集中在医疗保健过程的衡量标准上。因此，在电子计量框架内开发和传播风险模型所需的活动尚未得到处理。这是一个关键的差距，因为风险调整对于我们公平比较不同组织和患者人群的结果至关重要。本项目将评估纽约州长期建立和备受推崇的心脏护理结果指标的重组。具体而言，本项目将：目标1：根据以下评价，制定实用建议，将纸质纽约州心脏护理措施重新调整为eMeasure规范：a）。使用EHR收集特定数据元素的可行性; B）.特定风险因素的统计影响（目前用于纽约州心脏护理措施），并确定无法通过EHR收集的风险因素的替代影响; c）。如何最好地表示EHR中数据元素的临床意图（例如，值集）; d）.估计与修改现有EHR的建议相关的成本，这些建议可能需要捕获关键数据元素（包括确定包含此类数据元素可能如何影响临床医生工作流程）。目标二：将基于纸张的NYS Cardiac Care测量规范重新调整为eMeasure规范，以便来自不同EHR系统的数据可以等效地映射到收集数据和计算测量所需的测量数据元素（包括风险因素）。该项目的结果将提供有关如何在EHR环境中建立标准化的风险调整结果度量的有价值的信息。在公共政策一级，评估结果将有助于建立国家业绩比较，从而促进质量改进，并为公共和私营部门加强消费者选择和供应商问责制的努力提供信息。

 DESCRIPTION (provided by applicant): This research project assesses the ability of disparate electronic health records (EHRs) to collect standardized, risk adjusted and clinically relevant outcome measures. The introduction of the EHR holds promise for robust risk adjustment modeling that will enable fair comparisons of outcomes across different patients, treatments, providers, or populations without the costs associated with labor intensive data collection. To date the retooling of quality measures from paper-based formats to an electronic (eMeasure) format has primarily focused on measures of health care processes. As a result, the activities required to develop and disseminate risk models within the eMeasure framework have not been addressed. This is a critical gap, as risk adjustment is essential to our ability to make fair comparisons of outcome across different organizations and patient populations. This project will evaluate the retooling of long established and well respected outcome measures that address cardiac care in New York State. Specifically, this project will: Aim 1: Develop practical recommendations for retooling the paper-based NYS Cardiac Care measures into eMeasure specifications based upon an evaluation of: a). The feasibility of collecting the specific data elements using an EHR; b). The statistical influence of specific risk factors (currently used in th NYS Cardiac Care measure) and a determination of the impact of alternatives to those risk factors that cannot feasibly be collected through the EHR; c). How to best represent the clinical intent of data elements in an EHR (e.g. value sets); d). Estimate costs associated with recommendations to modify existing EHRs which may be needed to capture critical data elements (including a determination of how the inclusion of such data elements might impact clinician work flow). Aim 2: Retool the paper-based NYS Cardiac Care measure specifications into eMeasure specifications so that data from diverse EHR systems can be equivalently mapped to the measure data elements (including risk factors) that are required to collect the data and calculate the measure. The results of this project will provide valuable information about how to establish standardized risk adjusted outcomes measures in the EHR environment. At the public policy level, the results will facilitate the creation of national performance comparisons which can stimulate quality improvement, and inform public and private efforts to enhance consumer choice and provider accountability.