Jinnet B. Fowles

Review: Electronic Health Records and the Reliability and Validity of Quality Measures: A Review of the Literature

Previous reviews of research on electronic health record (EHR) data quality have not focused on the needs of quality measurement. The authors reviewed empirical studies of EHR data quality, published from January 2004, with an emphasis on data attributes relevant to quality measurement. Many of the 35 studies reviewed examined multiple aspects of data quality. Sixty-six percent evaluated data accuracy, 57% data completeness, and 23% data comparability. The diversity in data element, study setting, population, health condition, and EHR system studied within this body of literature made drawing specific conclusions regarding EHR data quality challenging. Future research should focus on the quality of data from specific EHR components and important data attributes for quality measurement such as granularity, timeliness, and comparability. Finally, factors associated with poor or variability in data quality need to be better understood and effective interventions developed.

“e-Iatrogenesis”: The Most Critical Unintended Consequence of CPOE and other HIT

In the September/October 2006 issues of JAMIA, Campbell et al.s article “Types of Unintended Consequences Related to Computerized Provider Order Entry”1 lays out an innovative and comprehensive framework for categorizing the things that can go wrong when CPOE systems are implemented. We commend the authors for helping to move forward our collective understanding of this important area. As CPOE and other components of health information technology (HIT) logarithmically diffuse across the U.S. health care system, it is clear they will eventually become the standard all-encompassing platform for the delivery of medical care. As has been the case for all previous medical and non-medical technologies, HIT dissemination carries with it both positive and negative consequences. All nine types of “unintended consequences” outlined by Campbell et al. in their article should be …

Validation of claims diagnoses and self-reported conditions compared with medical records for selected chronic diseases.

This article assesses the validity of ambulatory administrative and encounter data and patient self-reported information compared with information contained in the ambulatory medical record for 17 chronic diseases. Using a sample of 213 adults (18 to 64 years old) and seniors (65 years and older) enrolled in a health maintenance organization and receiving care at a multispecialty group practice in Minneapolis, Minnesota, sensitivity and specificity for claims and self-report were calculated for each chronic condition using the medical record as the criterion standard. The analysis was performed first by blinded review and then repeated with an unblinded review.

When activation changes, what else changes? the relationship between change in patient activation measure (PAM) and employees’ health status and health behaviors

OBJECTIVE To test whether changes in the patient activation measure (PAM) are related to changes in health status and healthy behaviors. METHODS Data for this secondary analysis were taken from a group-randomized, controlled trial comparing a traditional health promotion program for employees with an activated consumer program and a control program. The study population included 320 employees (with and without chronic disease) from two U.S. companies: a large, integrated health care system and a national airline. Survey and biometric data were collected in Spring 2005 (baseline) and Spring 2007 (follow-up). RESULTS Change in PAM was associated with changes in health behaviors at every level (1-4), especially at level 4. Changes related to overall risk score and many of its components: aerobic exercise, safety, cancer risk, stress and mental health. Other changes included frequency of eating breakfast and the likelihood of knowing about health plans and how they compare. CONCLUSION Level 4 of patient activation is not an end-point. People are capable of continuing to make significant change within this level. PRACTICE IMPLICATIONS Interventions should be designed to encourage movement from lower to higher levels of activation. Even people at the most activated level improve health behaviors.

Developing and evaluating performance measures for ambulatory care quality: a preliminary report of the DEMPAQ project.

Because of the focus on technical quality, the content of the DEMPAQ performance measures is clinically detailed and oriented toward processes of care relevant to the everyday practice of medicine in the ambulatory setting. This emphasis is crucial if the performance measures are to be useful to practicing physicians.

Comparing Claims Data and Self-Reported Data with the Medical Record for Pap Smear Rates

The objective of this study was to assess and compare the relative accuracy of claims data and patient self-reported information with medical records for Pap smear rates. A retrospective analysis of information obtainedfrom administrative claims files, patient medical records, and a telephone survey was performed of 400 women age 19 through 75years who were randomly selectedfor participation in the study. The data were obtained from a large multispecialty group practice in Minneapolis, Minnesota for the study years 1991 through 1993. Information from administrative claims regarding Pap smear status corresponded highly with information in the medical record (sensitivity 95% or higher; specificity 95% or higher; kappa 0.896 or better). Self-reported information from the telephone survey did not correspond well with medical record information nor with results in administrative claims.

Designing and using measures of quality based on physician office records

This article presents our principles for developing performance measures to assess the quality of ambulatory care. The measures were developed as part of a project for developing and evaluating methods to promote ambulatory care quality (DEMPAQ). We describe our design for the performance measures, present examples of the DEMPAQ review criteria, and show the formats we used to feed back information to physicians. We conclude by presenting the results of our appralsal of the performance measures showing how evaluation can aid in the interpretation of measurement findings.

Developing a Quality Improvement Database Using Health Insurance Data: A Guided Tour with Application to Medicare's National Claims History File

Health policy researchers are increasingly turning to insurance claims to provide timely information on cost, utilization, and quality trends in health care markets. This research offers an in-depth description of how to systematically transform raw inpatient and ambulatory claims data into useful information for health care management and research using the Health Care Financing Administrations National Claims History file as an example. The topics covered include: (a) understanding the contents and architecture of claims data, (b) creating analytic files from raw claims, (c) technical innovations for health policy studies, (d) assessing data accuracy, (d) the costs of using claims data, and (e) ensuring confidentiality. In summary, claims data are found to have great potential for quality of care analysis. As in any analysis, careful development of a database is required for scientific research. The methods outlined in this study offer health data novices as well as experienced analysts a series of strategies to maximize the value of claims data for health policy analysis.

Pneumococcal vaccine administration associated with splenectomy: missed opportunities

BACKGROUND The spleen defends against infection from encapsulated organisms. Patients who have had splenectomies are at risk for the development of overwhelming pneumococcal infections. Guidelines recommend that pneumococcal vaccine be given to all patients who have splenectomies. METHODS This retrospective study was performed to evaluate compliance with the guidelines in patients from a large multispecialty group practice who had splenectomies between 1988 and 1991. Ninety-five patients were identified, and their clinic and hospital records were reviewed. RESULTS Overall, 73.7% of patients who had splenectomies received the pneumococcal vaccine. No significant differences were found in the vaccination rates over time or among the surgeons. CONCLUSIONS Improvement is needed in ensuring that patients who have splenectomies receive pneumococcal vaccine.

Evaluation of medical-technology strategies: effects of coverage and reimbursement (first of two parts).

Rationale The current federal policy is to reduce the governments responsibility for health care and its evaluation, substituting market mechanisms whenever possible, and to vest residual control ...