电子报告的“有意义使用”临床质量指标的准确性：一项横断面研究。

Accuracy of electronically reported "meaningful use" clinical quality measures: a cross-sectional study.

机构信息

Center for Healthcare Informatics and Policy, Weill Cornell Medical College, Institute for Family Health, New York, USA.

出版信息

Ann Intern Med. 2013 Jan 15;158(2):77-83. doi: 10.7326/0003-4819-158-2-201301150-00001.

DOI:10.7326/0003-4819-158-2-201301150-00001

PMID:23318309

Abstract

BACKGROUND

The federal Electronic Health Record Incentive Program requires electronic reporting of quality from electronic health records, beginning in 2014. Whether electronic reports of quality are accurate is unclear.

OBJECTIVE

To measure the accuracy of electronic reporting compared with manual review.

DESIGN

Cross-sectional study.

SETTING

A federally qualified health center with a commercially available electronic health record.

PATIENTS

All adult patients eligible in 2008 for 12 quality measures (using 8 unique denominators) were identified electronically. One hundred fifty patients were randomly sampled per denominator, yielding 1154 unique patients.

MEASUREMENTS

Receipt of recommended care, assessed by both electronic reporting and manual review. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and absolute rates of recommended care were measured.

RESULTS

Sensitivity of electronic reporting ranged from 46% to 98% per measure. Specificity ranged from 62% to 97%, positive predictive value from 57% to 97%, and negative predictive value from 32% to 99%. Positive likelihood ratios ranged from 2.34 to 24.25 and negative likelihood ratios from 0.02 to 0.61. Differences between electronic reporting and manual review were statistically significant for 3 measures: Electronic reporting underestimated the absolute rate of recommended care for 2 measures (appropriate asthma medication [38% vs. 77%; P < 0.001] and pneumococcal vaccination [27% vs. 48%; P < 0.001]) and overestimated care for 1 measure (cholesterol control in patients with diabetes [57% vs. 37%; P = 0.001]).

LIMITATION

This study addresses the accuracy of the measure numerator only.

CONCLUSION

Wide measure-by-measure variation in accuracy threatens the validity of electronic reporting. If variation is not addressed, financial incentives intended to reward high quality may not be given to the highest-quality providers.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

摘要

背景

联邦电子健康记录激励计划要求从电子健康记录中报告质量，自 2014 年开始。电子报告的质量是否准确尚不清楚。

目的

测量电子报告与手工审查相比的准确性。

设计

横断面研究。

设置

一家具有商业电子健康记录的联邦合格健康中心。

患者

2008 年，所有符合 12 项质量措施标准（使用 8 个独特的分母）的成年患者都被电子识别。每个分母随机抽取 150 名患者，产生 1154 名独特患者。

测量

通过电子报告和手工审查评估建议的护理的接受情况。测量了电子报告的敏感性、特异性、阳性和阴性预测值、阳性和阴性似然比以及推荐护理的绝对比例。

结果

电子报告的敏感性为每个措施的 46%至 98%。特异性为 62%至 97%，阳性预测值为 57%至 97%，阴性预测值为 32%至 99%。阳性似然比为 2.34 至 24.25，阴性似然比为 0.02 至 0.61。电子报告与手工审查之间的差异在 3 项措施上具有统计学意义：电子报告低估了 2 项措施（适当的哮喘药物[38%比 77%；P <0.001]和肺炎球菌疫苗[27%比 48%；P <0.001]）和高估了 1 项措施（糖尿病患者的胆固醇控制[57%比 37%；P = 0.001]）。