Greiver Michelle, Wintemute Kimberly, Aliarzadeh Babak, Martin Ken, Khan Shahriar, Jackson Dave, Leggett Jannet, Lambert-Lanning Anita, Siu Maggie
University of Toronto Department of Family and Community Medicine.
Department of Family and Community Medicine, University of Toronto, Toronto;North York General Hospital, Toronto; North York Family Health Team, Toronto.
J Innov Health Inform. 2016 Oct 12;23(3):843. doi: 10.14236/jhi.v23i3.843.
Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions.
Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada.
Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%-8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%-9.5%, p < 0.01).
Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.
慢性病的一致且标准化编码与更好的医疗服务相关；然而，目前在加拿大初级医疗中使用的电子病历（EMR）里，编码可能存在局限。目的：在一个社区初级医疗组织中开展数据管理活动，并评估其对慢性病编码的影响。
安大略省多伦多市隶属于同一个初级医疗组织的59名家庭医生参与了该研究。该组织建立了一个中央分析数据存储库，其中包含由加拿大初级医疗哨点监测网络（CPCSSN）提取、清理、标准化并返回的电子病历数据，CPCSSN是一个经过大量验证的基于初级医疗电子病历的数据库。他们使用CPCSSN提供的报告软件来识别选定的慢性病，然后将标准化代码添加回电子病历中。我们研究了四种慢性病（糖尿病、高血压、慢性阻塞性肺疾病和痴呆症）。我们将该组织内医生在六个月内编码的变化与全加拿大参与CPCSSN的315名初级医疗医生的编码变化进行了比较。
该组织内慢性病编码的增加幅度明显高于其他初级医疗场所。编码增加的调整差异为7.7%（95%置信区间7.1%-8.2%，p<0.01）。由CPCSSN数据库中每种疾病最常见诊断代码组成的标准代码的使用增加了8.9%以上（95%置信区间8.3%-9.5%，p<0.01）。
数据管理活动与慢性病标准化编码的增加相关。探索在加拿大初级医疗组织中扩大和推广这种方法的要求可能是值得的。
