Baus Adam, Hendryx Michael, Pollard Cecil
Office of Health Services Research, West Virginia University, Department of Community Medicine, Morgantown, WV, USA.
Perspect Health Inf Manag. 2012;9(Spring):1e. Epub 2012 Apr 1.
Problems in the structure, consistency, and completeness of electronic health record data are barriers to outcomes research, quality improvement, and practice redesign. This nonexperimental retrospective study examines the utility of importing de-identified electronic health record data into an external system to identify patients with and at risk for essential hypertension. We find a statistically significant increase in cases based on combined use of diagnostic and free-text coding (mean = 1,256.1, 95% CI 1,232.3-1,279.7) compared to diagnostic coding alone (mean = 1,174.5, 95% CI 1,150.5-1,198.3). While it is not surprising that significantly more patients are identified when broadening search criteria, the implications are critical for quality of care, the movement toward the National Committee for Quality Assurance's Patient-Centered Medical Home program, and meaningful use of electronic health records. Further, we find a statistically significant increase in potential cases based on the last two or more blood pressure readings greater than or equal to 140/90 mm Hg (mean = 1,353.9, 95% CI 1,329.9-1,377.9).
电子健康记录数据在结构、一致性和完整性方面存在的问题，是影响疗效研究、质量改进及实践重新设计的障碍。这项非实验性回顾性研究，考察了将去识别化的电子健康记录数据导入外部系统，以识别原发性高血压患者及其风险人群的效用。我们发现，与仅使用诊断编码相比（均值 = 1,174.5，95%置信区间1,150.5 - 1,198.3），联合使用诊断编码和自由文本编码可使病例数显著增加（均值 = 1,256.1，95%置信区间1,232.3 - 1,279.7）。虽然扩大搜索标准时识别出更多患者并不意外，但这对医疗质量、朝着美国国家质量保证委员会的以患者为中心的医疗之家计划迈进以及电子健康记录的有意义使用都具有关键意义。此外，我们发现，基于最近两次或更多次血压读数大于或等于140/90毫米汞柱，潜在病例数有统计学意义的增加（均值 = 1,353.9，95%置信区间1,329.9 - 1,377.9）。
