de Lusignan Simon, Hague Nigel, Brown Adrian, Majeed Azeem
Primary Care Informatics, Department of General Practice and Primary Care, St. George's Hospital Medical School, London SW17 0RE.
J Public Health (Oxf). 2004 Mar;26(1):34-7. doi: 10.1093/pubmed/fdh104.
Gaps in computerized medical records and a lack of a systematic approach to data recording make progress towards achieving quality standards in primary care difficult to demonstrate. The aim of this study was to examine the effect of an educational intervention on data quality in primary care.
A before-and-after study of key data quality measures was carried out in 87 general practices in eight primary care organizations in England in phase 1 and 84 general practices in phase 2. The subjects were 19,470 patients with ischaemic heart disease in phase 1 and 19,784 patients in phase 2. The main outcome measures were improvement in the completeness and quality of the computerized medical record. Anonymized data were extracted from clinical information systems and processed to produce comparative information on each practice. Data quality workshops were arranged, in which reflection can take place, backed up by summary statistics. Practice visits provided training and personalized feedback of patients needing intervention.
In the patients with heart disease, nearly 16,000 new clinical entries were made in the key improvement areas. The percentage of patients advised to quit smoking increased by 49.3 per cent, from 23.6 per cent to 61.9 per cent. There were also significant improvements in many other aspects of management.
Focused interventions that provide targeted and relevant clinical information can be implemented in primary care. Such interventions can lead to a rise in data quality in primary care, but their effectiveness needs to be further tested in more rigorous research settings such as randomized controlled trials.
电子病历存在缺陷，且缺乏系统的数据记录方法，这使得在初级医疗保健中实现质量标准的进展难以得到证明。本研究的目的是检验教育干预对初级医疗保健数据质量的影响。
在第1阶段，对英格兰8个初级医疗保健机构中的87家全科诊所进行了关键数据质量指标的前后对照研究；在第2阶段，研究对象为84家全科诊所。第1阶段的受试者为19470例缺血性心脏病患者，第2阶段为19784例。主要结局指标是电子病历完整性和质量的改善。从临床信息系统中提取匿名数据并进行处理，以生成每家诊所的比较信息。安排了数据质量研讨会，会上可进行反思，并提供汇总统计数据作为支持。实地考察提供了培训以及针对需要干预患者的个性化反馈。
在心脏病患者中，关键改善领域新增了近16000条临床记录。建议戒烟的患者比例从23.6%增至61.9%，增幅为49.3%。在管理的许多其他方面也有显著改善。
在初级医疗保健中可实施提供有针对性和相关性临床信息的重点干预措施。此类干预措施可提高初级医疗保健中的数据质量，但其有效性需要在更严格的研究环境（如随机对照试验）中进一步检验。
