Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
BMC Health Serv Res. 2010 May 26;10:137. doi: 10.1186/1472-6963-10-137.
Information on prescribing quality is increasingly used by policy makers, insurance companies and health care providers. For reliable assessment of prescribing quality it is important to correctly identify the patients eligible for recommended treatment. Often either diagnostic codes or clinical measurements are used to identify such patients. We compared these two approaches regarding the outcome of the prescribing quality assessment and their ability to identify treated and undertreated patients.
The approaches were compared using electronic health records for 3214 diabetes patients from 70 general practitioners. We selected three existing prescribing quality indicators (PQI) assessing different aspects of treatment in patients with hypertension or who were overweight. We compared population level prescribing quality scores and proportions of identified patients using definitions of hypertension or being overweight based on diagnostic codes, clinical measurements or both.
The prescribing quality score for prescribing any antihypertensive treatment was 93% (95% confidence interval 90-95%) using the diagnostic code-based approach, and 81% (78-83%) using the measurement-based approach. Patients receiving antihypertensive treatment had a better registration of their diagnosis compared to hypertensive patients in whom such treatment was not initiated. Scores on the other two PQI were similar for the different approaches, ranging from 64 to 66%. For all PQI, the clinical measurement -based approach identified higher proportions of both well treated and undertreated patients compared to the diagnostic code -based approach.
The use of clinical measurements is recommended when PQI are used to identify undertreated patients. Using diagnostic codes or clinical measurement values has little impact on the outcomes of proportion-based PQI when both numerator and denominator are equally affected. In situations when a diagnosis is better registered for treated than untreated patients, as we observed for hypertension, the diagnostic code-based approach results in overestimation of provided treatment.
政策制定者、保险公司和医疗保健提供者越来越多地使用处方质量信息。为了可靠地评估处方质量，正确识别符合推荐治疗的患者非常重要。通常使用诊断代码或临床测量值来识别此类患者。我们比较了这两种方法在处方质量评估的结果及其识别治疗和未治疗患者的能力。
使用来自 70 名全科医生的 3214 名糖尿病患者的电子健康记录来比较这两种方法。我们选择了三个现有的处方质量指标（PQI），评估高血压或超重患者治疗的不同方面。我们比较了使用基于诊断代码的方法和基于临床测量的方法来定义高血压或超重时，人群水平的处方质量评分和被识别患者的比例。
使用基于诊断代码的方法，开具任何降压治疗的处方质量评分为 93%（95%置信区间 90-95%），而使用基于临床测量的方法为 81%（78-83%）。接受降压治疗的患者的诊断记录比未开始此类治疗的高血压患者更好。其他两个 PQI 的评分对于不同的方法相似，范围在 64 到 66%之间。对于所有 PQI，基于临床测量的方法比基于诊断代码的方法识别出更高比例的治疗良好和治疗不足的患者。
当使用 PQI 来识别未治疗的患者时，建议使用临床测量值。当分子和分母都受到同等影响时，使用诊断代码或临床测量值对基于比例的 PQI 的结果影响很小。在诊断对治疗患者的记录优于未治疗患者的情况下，如我们在高血压中观察到的那样，基于诊断代码的方法会导致提供的治疗被高估。
