Informatics Department, Diameter Health, Farmington, Connecticut, USA.
Kansas Health Information Network, Topeka, Kansas, USA.
J Am Med Inform Assoc. 2021 Jul 14;28(7):1534-1542. doi: 10.1093/jamia/ocab039.
Accurate and robust quality measurement is critical to the future of value-based care. Having incomplete information when calculating quality measures can cause inaccuracies in reported patient outcomes. This research examines how quality calculations vary when using data from an individual electronic health record (EHR) and longitudinal data from a health information exchange (HIE) operating as a multisource registry for quality measurement.
Data were sampled from 53 healthcare organizations in 2018. Organizations represented both ambulatory care practices and health systems participating in the state of Kansas HIE. Fourteen ambulatory quality measures for 5300 patients were calculated using the data from an individual EHR source and contrasted to calculations when HIE data were added to locally recorded data.
A total of 79% of patients received care at more than 1 facility during the 2018 calendar year. A total of 12 994 applicable quality measure calculations were compared using data from the originating organization vs longitudinal data from the HIE. A total of 15% of all quality measure calculations changed (P < .001) when including HIE data sources, affecting 19% of patients. Changes in quality measure calculations were observed across measures and organizations.
These results demonstrate that quality measures calculated using single-site EHR data may be limited by incomplete information. Effective data sharing significantly changes quality calculations, which affect healthcare payments, patient safety, and care quality.
Federal, state, and commercial programs that use quality measurement as part of reimbursement could promote more accurate and representative quality measurement through methods that increase clinical data sharing.
准确且稳健的质量衡量对于基于价值的医疗保健的未来至关重要。在计算质量衡量标准时，如果信息不完整，可能会导致报告的患者结果出现不准确的情况。本研究考察了当使用来自单个电子健康记录 (EHR) 的数据和来自作为质量衡量多源登记处运作的健康信息交换 (HIE) 的纵向数据进行质量计算时，质量计算会如何变化。
数据取自 2018 年的 53 个医疗保健组织。这些组织代表了参与堪萨斯州 HIE 的门诊医疗实践和医疗系统。使用来自单个 EHR 源的数据计算了 5300 名患者的 14 项门诊质量衡量标准，并将其与添加 HIE 数据后的本地记录数据进行了对比。
在 2018 年的日历年中，共有 79%的患者在多个医疗机构接受了治疗。使用原始组织的数据和 HIE 的纵向数据对总共 12994 项适用的质量衡量标准计算进行了比较。当包含 HIE 数据源时，所有质量衡量标准计算中有 15%发生了变化 (P < .001)，影响了 19%的患者。在各个指标和组织中都观察到了质量衡量标准计算的变化。
这些结果表明，使用单个站点 EHR 数据计算的质量衡量标准可能会受到不完整信息的限制。有效的数据共享会显著改变质量计算，从而影响医疗保健支付、患者安全和护理质量。
联邦、州和商业计划将质量衡量作为报销的一部分，通过增加临床数据共享的方法，可以促进更准确和更具代表性的质量衡量。
