Division of Social Protection and Health, Inter-American Development Bank, Washignton, USA.
BMC Med Inform Decis Mak. 2012 Jun 6;12:50. doi: 10.1186/1472-6947-12-50.
Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM.
We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009.
We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose≤130 mg/dl).
EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC.
一些中低收入国家正在实施电子健康记录（EHR）。如果开发出适当的指标，EHR 可能在不久的将来成为评估医疗保健绩效的有效工具。本研究的目的是：a）为墨西哥社会保障研究所（IMSS）卫生系统的 2 型糖尿病（T2DM）制定护理质量指标（QCIs）；b）确定使用 IMSS EHR 数据构建 QCIs 的可行性；c）评估 IMSS 2 型糖尿病患者的护理质量（QC）。
我们使用了三阶段混合方法：a）采用 RAND-UCLA 方法制定 QCIs；b）从 2009 年接受治疗的 25130 名 T2DM 患者的 EHR 数据中提取和构建指标；c）使用 EHR 数据评估 QC。
我们开发了 18 个 QCIs，其中 14 个可以使用现有 EHR 数据构建。QCIs 包括护理过程和健康结果。发现 EHR 设计和数据质量存在一些缺陷。护理过程和结果的指标表明了需要改进的地方。例如，只有 13.0%的患者被转诊给眼科医生；3.9%的患者接受营养咨询；63.2%的超重/肥胖患者开了二甲双胍，只有 23%的患者 HbA1c<7%（或血浆葡萄糖≤130mg/dl）。
EHR 数据可用于评估 QC。结果既确定了电子信息系统在 IMSS 的 T2DM 护理过程和结果中的优势和劣势。这些信息可用于指导有针对性的干预措施，以提高 QC。
