University of Utah College of Pharmacy, Department of Pharmacotherapy, Salt Lake City, UT 84112, USA.
Curr Med Res Opin. 2010 Aug;26(8):1881-91. doi: 10.1185/03007995.2010.489785.
Use of electronic medical record (EMR) data for evaluating healthcare processes and outcomes is relatively new. Using EMR data, this study evaluated the time from antihypertensive initiation to the first follow-up office visit controlling for adverse events (AEs) and other factors that could influence follow-up timing. Findings were compared to treatment guidelines which recommend monthly follow-up in treatment naive patients until blood pressure (BP) levels are controlled.
Treatment-naïve hypertensive adult patients in the General Electric Centricity EMR database (1996-2006) with a new antihypertensive prescription were evaluated. Time from treatment initiation to first office visit was identified and stratified by occurrence of AEs and therapy change. BP was assessed at 120 +/- 30 days.
The mean +/- SD time from first antihypertensive prescription (index date) to the first office visit was 96.2 +/- 160.6 days; 38% returned within a month of treatment initiation. Controlling for baseline demographic and clinical characteristics, the adjusted time until first office visit was shorter for those with an AE and therapy change than for those with neither event (61 vs. 158 days). Of the patients with follow-up BP data for analysis (n = 27,875), more of those seen within a month of treatment initiation achieved BP goal at 120 days (<140/90 mmHg) than those who were not seen within a month (64.3 vs. 61.7% respectively; p < 0.001).
This study demonstrates that EMR data can be used to assess quality measures which in turn can inform efforts to improve treatment outcomes. Specifically, this study evaluated mean time to first office visit after antihypertensive therapy initiation controlling for clinical factors that could influence office visit intervals based on data available in a national EMR dataset. A key limitation of this study is that the EMR may not represent patient care delivered by other providers, thus, use of antihypertensives, changes in therapy, and office visits may be underreported.
使用电子病历 (EMR) 数据来评估医疗保健流程和结果相对较新。本研究使用 EMR 数据，评估了从开始抗高血压治疗到首次随访就诊的时间，同时控制了不良事件 (AE) 和其他可能影响随访时间的因素。研究结果与治疗指南进行了比较，该指南建议在治疗初期的患者每月进行随访，直到血压 (BP) 水平得到控制。
评估了通用电气 Centricity EMR 数据库（1996-2006 年）中患有新的抗高血压处方的治疗初期高血压成年患者。确定了从开始治疗到首次就诊的时间，并根据 AE 和治疗改变的发生情况进行了分层。在 120 +/- 30 天评估 BP。
从首次开抗高血压处方（索引日期）到首次就诊的平均 +/- SD 时间为 96.2 +/- 160.6 天；38%的患者在治疗开始后一个月内返回。控制基线人口统计学和临床特征后，与既无 AE 也无治疗改变的患者相比，有 AE 和治疗改变的患者首次就诊的调整时间更短（61 天比 158 天）。在有随访 BP 数据可供分析的患者（n = 27875）中，在治疗开始后一个月内就诊的患者在 120 天内达到 BP 目标（<140/90 mmHg）的比例高于未在一个月内就诊的患者（分别为 64.3%比 61.7%；p < 0.001）。
本研究表明，EMR 数据可用于评估质量指标，从而为改善治疗结果提供信息。具体来说，本研究评估了从开始抗高血压治疗到首次就诊的平均时间，同时控制了可能影响就诊间隔的临床因素，这些因素是基于全国 EMR 数据集提供的数据。本研究的一个主要局限性是 EMR 可能无法代表其他提供者提供的患者护理，因此，抗高血压药物的使用、治疗改变和就诊可能报告不足。
