美国风湿病学会风湿病信息系统有效性注册研究（RISE）中电子健康记录系统与质量指标绩效之间的关系：观察性研究
The Relationship Between Electronic Health Record System and Performance on Quality Measures in the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) Registry: Observational Study.
作者信息
Hammam Nevin, Izadi Zara, Li Jing, Evans Michael, Kay Julia, Shiboski Stephen, Schmajuk Gabriela, Yazdany Jinoos
机构信息
Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, United States.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.
出版信息
JMIR Med Inform. 2021 Nov 12;9(11):e31186. doi: 10.2196/31186.
BACKGROUND
Routine collection of disease activity (DA) and patient-reported outcomes (PROs) in rheumatoid arthritis (RA) are nationally endorsed quality measures and critical components of a treat-to-target approach. However, little is known about the role electronic health record (EHR) systems play in facilitating performance on these measures.
OBJECTIVE
Using the American College Rheumatology's (ACR's) RISE registry, we analyzed the relationship between EHR system and performance on DA and functional status (FS) quality measures.
METHODS
We analyzed data collected in 2018 from practices enrolled in RISE. We assessed practice-level performance on quality measures that require DA and FS documentation. Multivariable linear regression and zero-inflated negative binomial models were used to examine the independent effect of EHR system on practice-level quality measure performance, adjusting for practice characteristics and patient case-mix.
RESULTS
In total, 220 included practices cared for 314,793 patients with RA. NextGen was the most commonly used EHR system (34.1%). We found wide variation in performance on DA and FS quality measures by EHR system (median 30.1, IQR 0-74.8, and median 9.0, IQR 0-74.2), respectively). Even after adjustment, NextGen practices performed significantly better than Allscripts on the DA measure (51.4% vs 5.0%; P<.05) and significantly better than eClinicalWorks and eMDs on the FS measure (49.3% vs 29.0% and 10.9%; P<.05).
CONCLUSIONS
Performance on national RA quality measures was associated with the EHR system, even after adjusting for practice and patient characteristics. These findings suggest that future efforts to improve quality of care in RA should focus not only on provider performance reporting but also on developing and implementing rheumatology-specific standards across EHRs.
背景
类风湿关节炎（RA）中疾病活动度（DA）和患者报告结局（PROs）的常规收集是国家认可的质量指标，也是达标治疗方法的关键组成部分。然而，关于电子健康记录（EHR）系统在促进这些指标的执行方面所起的作用，我们了解甚少。
目的
利用美国风湿病学会（ACR）的RISE注册登记系统，我们分析了EHR系统与DA和功能状态（FS）质量指标执行情况之间的关系。
方法
我们分析了2018年从参与RISE的医疗机构收集的数据。我们评估了在需要DA和FS记录的质量指标方面的机构层面执行情况。使用多变量线性回归和零膨胀负二项式模型来检验EHR系统对机构层面质量指标执行情况的独立影响，并对机构特征和患者病例组合进行调整。
结果
总共220家纳入研究的医疗机构为314,793例RA患者提供治疗。NextGen是最常用的EHR系统（34.1%）。我们发现不同EHR系统在DA和FS质量指标的执行情况上存在很大差异（DA指标的中位数为30.1，四分位数间距为0 - 74.8；FS指标的中位数为9.0，四分位数间距为0 - 74.2）。即使经过调整，使用NextGen系统的医疗机构在DA指标上的表现仍显著优于使用Allscripts系统的机构（51.4%对5.0%；P <.05），在FS指标上的表现显著优于使用eClinicalWorks和eMDs系统的机构（49.3%对29.0%和10.9%；P <.05）。
结论
即使对机构和患者特征进行了调整，全国RA质量指标的执行情况仍与EHR系统相关。这些发现表明，未来改善RA护理质量的努力不仅应关注医疗服务提供者的绩效报告，还应注重制定和实施跨EHR系统的风湿病特定标准。
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