de Lusignan S
Primary Care Informatics, Division of Community Health Sciences, St. George's, University of London, London, UK.
Methods Inf Med. 2007;46(1):57-62.
To report the lessons learned from eight years of feeding back routinely collected cardiovascular data in an educational context
There are distinct educational and technical components. The educational component provides peer-led learning opportunities based on comparative analysis of quality of care, as represented in computer records. The technical part ensures that relevant evidence-based audit criteria are identified; an appropriate dataset is extracted and processed to facilitate quality improvement. Anonymised data are used to provide inter-practice comparisons, with lists of identifiable patients who need interventions left in individual practices.
The progressive improvement in cholesterol management in ischaemic heart disease (IHD) is used as an exemplar of the changes achieved. Over three iterations of the cardiovascular programme the standardised prevalence of IHD recorded in GP computer systems rose from 3.8% to 4.0%. Cholesterol recording rose from 47.6% to 89.0%; and the mean cholesterol level fell from 5.18 to 4.67 mmol/L; while statin prescribing rose from 46% to 57% to 68%. The atrial fibrillation, heart failure and renal programmes (more people with chronic kidney disease go on to die from cardiovascular cause than from end-stage renal disease) are used to demonstrate the range of cardiovascular interventions amenable to this approach.
Technical progress has meant that larger datasets can be extracted and processed. Feedback of routinely collected data in an educational context is acceptable to practitioners and results in quality improvement. Further research is needed to assess its utility as a strategy and cost-effectiveness compared with other methods.
报告在教育背景下反馈常规收集的心血管数据八年来所吸取的经验教训
存在不同的教育和技术组成部分。教育部分基于对计算机记录中所体现的医疗质量的比较分析，提供由同行主导的学习机会。技术部分确保确定相关的循证审核标准；提取并处理适当的数据集以促进质量改进。使用匿名数据进行实践间比较，而将需要干预的可识别患者名单留在各个实践中。
缺血性心脏病（IHD）胆固醇管理的逐步改善被用作所取得变化的范例。在心血管项目的三轮实施过程中，全科医生计算机系统中记录的IHD标准化患病率从3.8%升至4.0%。胆固醇记录从47.6%升至89.0%；平均胆固醇水平从5.18降至4.67 mmol/L；而他汀类药物处方从46%升至57%再升至68%。房颤、心力衰竭和肾脏项目（更多慢性肾病患者死于心血管原因而非终末期肾病）被用于证明适用于这种方法的一系列心血管干预措施。
技术进步意味着可以提取和处理更大的数据集。在教育背景下反馈常规收集的数据为从业者所接受，并能带来质量改进。需要进一步研究以评估其作为一种策略的效用以及与其他方法相比的成本效益。
