Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada.
HEC Montréal, University of Montreal, 3000 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T2A7, Canada.
BMC Fam Pract. 2019 Jul 3;20(1):92. doi: 10.1186/s12875-019-0979-7.
Despite the increasing use of medical records to measure quality of care, studies have shown that their validity is suboptimal. The objective of this study is to assess the concordance of cardiovascular care processes evaluated through medical record review and patient self-administered questionnaires (SAQs) using ten quality indicators (TRANSIT indicators). These indicators were developed as part of a participatory research program (TRANSIT study) dedicated to TRANSforming InTerprofessional clinical practices to improve cardiovascular disease (CVD) prevention in primary care.
For every patient participating in the TRANSIT study, the compliance to each indicator (individual scores) as well as the mean compliance to all indicators of a category (subscale scores) and to the complete set of ten indicators (overall scale score) were established. Concordance between results obtained using medical records and patient SAQs was assessed by prevalence-adjusted bias-adjusted kappa (PABAK) coefficients as well as intraclass correlation coefficients (ICCs) and 95% confidence intervals (95% CI). Generalized linear mixed models (GLMM) were used to identify patients' sociodemographic and clinical characteristics associated with agreement between the two data sources.
The TRANSIT study was conducted in a primary care setting among patients (n = 759) with multimorbidity, at moderate (16%) and high risk (83%) of cardiovascular diseases. Quality of care, as measured by the TRANSIT indicators, varied substantially between medical records and patient SAQ. Concordance between the two data sources, as measured by ICCs (95% CI), was poor for the subscale (0.18 [0.08-0.27] to 0.46 [0.40-0.52]) and overall (0.46 [0.40-0.53]) compliance scale scores. GLMM showed that agreement was not affected by patients' characteristics.
In quality improvement strategies, researchers must acknowledge that care processes may not be consistently recorded in medical records. They must also be aware that the evaluation of the quality of care may vary depending on the source of information, the clinician responsible of documenting the interventions, and the domain of care.
尽管越来越多地使用医疗记录来衡量医疗质量，但研究表明其有效性并不理想。本研究的目的是评估通过病历审查和患者自我管理问卷（SAQ）评估的心血管护理过程的一致性，使用十个质量指标（TRANSIT 指标）。这些指标是作为一个参与式研究计划（TRANSIT 研究）的一部分制定的，该计划致力于通过跨专业临床实践改善初级保健中的心血管疾病（CVD）预防。
对于参与 TRANSIT 研究的每位患者，确定每个指标的合规性（个体评分）以及一个类别中所有指标的平均合规性（子量表评分）以及十个指标的完整集（整体量表评分）。通过调整后偏倚调整后的 Kappa（PABAK）系数以及组内相关系数（ICC）和 95%置信区间（95%CI）评估使用病历和患者 SAQ 获得的结果之间的一致性。使用广义线性混合模型（GLMM）来确定与两种数据源之间一致性相关的患者社会人口统计学和临床特征。
TRANSIT 研究在初级保健环境中进行，纳入了患有多种疾病的患者（n=759），这些患者有中等（16%）和高（83%）心血管疾病风险。使用 TRANSIT 指标衡量的医疗质量在病历和患者 SAQ 之间差异很大。两种数据源之间的一致性，通过 ICC（95%CI）衡量，子量表（0.18 [0.08-0.27]至 0.46 [0.40-0.52]）和整体（0.46 [0.40-0.53]）合规性量表得分较差。GLMM 表明，一致性不受患者特征的影响。
在质量改进策略中，研究人员必须认识到医疗记录中可能没有一致记录护理过程。他们还必须意识到，护理质量的评估可能因信息来源、负责记录干预措施的临床医生以及护理领域而异。
