University of Western Ontario, Centre for Studies in Family Medicine, 245-100 Collip Circle, London, ON N6G 4X8.
Can Fam Physician. 2010 Dec;56(12):e432-7.
To study the feasibility of using electronic medical record (EMR) data from the Deliver Primary Healthcare Information (DELPHI) database to measure quality of care for patients with congestive heart failure (CHF) in primary care and to determine the percentage of patients with CHF receiving the recommended care.
Items listed on the Ontario Ministry of Health and Long-Term Care Heart Failure Patient Care Flow Sheet (CHF flow sheet) were assessed and measured using EMRs of patients diagnosed with CHF between October 1, 2005, and September 30, 2008.
Ten primary health care practices in southwestern Ontario.
Four hundred eighty-eight patients who were considered to have CHF because at least 1 of the following was indicated in their EMRs: an International Classification of Diseases billing code for CHF (category 428), an International Classification of Primary Care diagnosis code for heart failure (ie, K77), or "CHF" reported on the problem list.
Number of CHF flow sheet items that were measurable using EMR data from the DELPHI database. Percentage of patients with CHF receiving required quality-of-care items since the date of diagnosis.
The DELPHI database contained information on 60 (65.9%) of the 91 items identified using the CHF flow sheet. The recommended tests and procedures were recorded infrequently: 55.5% of patients with CHF had chest radiographs; 32.6% had electrocardiograms; 32.2% had echocardiograms; 30.5% were prescribed angiotensin-converting enzyme inhibitors; 20.9% were prescribed β-blockers; and 15.8% were prescribed angiotensin II receptor blockers.
Low frequencies of recommended care items for patients with CHF were recorded in the EMR. Physicians explained that CHF care was documented in areas of the EMR that contained patient identifiers, such as the encounter notes, and was therefore not part of the DELPHI database. Extractable information from the EMR does not provide a complete picture of the quality of care provided to patients with CHF.
研究使用 Deliver Primary Healthcare Information（DELPHI）数据库中的电子病历（EMR）数据来衡量初级保健中充血性心力衰竭（CHF）患者护理质量的可行性，并确定接受推荐护理的 CHF 患者的百分比。
评估并测量了 2005 年 10 月 1 日至 2008 年 9 月 30 日期间被诊断为 CHF 的患者的安大略省卫生部和长期护理部心力衰竭患者护理流程表（CHF 流程表）上列出的项目，并使用这些患者的 EMR 进行了测量。
安大略省西南部的 10 个初级保健实践。
488 名患者，他们的 EMR 中至少有以下一项表明他们患有 CHF：CHF 的国际疾病分类计费代码（类别 428）、初级保健国际分类诊断代码（即 K77）或“CHF”在问题清单上报告。
使用 DELPHI 数据库中的 EMR 数据可测量的 CHF 流程表项目数量。自诊断之日起，接受所需护理项目的 CHF 患者的百分比。
DELPHI 数据库包含了使用 CHF 流程表确定的 91 项中的 60 项（65.9%）的信息。推荐的检查和程序记录频率较低：55.5%的 CHF 患者有胸部 X 光片；32.6%有心电图；32.2%有超声心动图；30.5%被处方血管紧张素转换酶抑制剂；20.9%被处方β受体阻滞剂；15.8%被处方血管紧张素 II 受体阻滞剂。
在 EMR 中记录了 CHF 患者的推荐护理项目频率较低。医生解释说，CHF 护理记录在 EMR 中包含患者标识符的区域，例如就诊记录，因此不属于 DELPHI 数据库。从 EMR 中提取的信息并不能全面了解为 CHF 患者提供的护理质量。
