Yan Xiaowei, Stewart Walter F, Husby Hannah, Delatorre-Reimer Jake, Mudiganti Satish, Refai Farah, Hudnut Andrew, Knobel Kevin, MacDonald Karen, Sifakis Frangiscos, Jones James B
Sutter Center for Health System Research, 2121 N. California Blvd, Suite 310, Walnut Creek, CA 94596, USA.
Medcurio, Inc., Oakland, CA 94618, USA.
Healthcare (Basel). 2021 Dec 31;10(1):70. doi: 10.3390/healthcare10010070.
The objective of this study was to determine the strengths and limitations of using structured electronic health records (EHR) to identify and manage cardiometabolic (CM) health gaps. We used medication adherence measures derived from dispense data to attribute related therapeutic care gaps (i.e., no action to close health gaps) to patient- (i.e., failure to retrieve medication or low adherence) or clinician-related (i.e., failure to initiate/titrate medication) behavior. We illustrated how such data can be used to manage health and care gaps for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and HbA1c for 240,582 Sutter Health primary care patients. Prevalence of health gaps was 44% for patients with hypertension, 33% with hyperlipidemia, and 57% with diabetes. Failure to retrieve medication was common; this patient-related care gap was highly associated with health gaps (odds ratios (OR): 1.23-1.76). Clinician-related therapeutic care gaps were common (16% for hypertension, and 40% and 27% for hyperlipidemia and diabetes, respectively), and strongly related to health gaps for hyperlipidemia (OR = 5.8; 95% CI: 5.6-6.0) and diabetes (OR = 5.7; 95% CI: 5.4-6.0). Additionally, a substantial minority of care gaps (9% to 21%) were uncertain, meaning we lacked evidence to attribute the gap to either patients or clinicians, hindering efforts to close the gaps.
本研究的目的是确定使用结构化电子健康记录（EHR）来识别和管理心脏代谢（CM）健康差距的优势和局限性。我们使用从配药数据中得出的药物依从性指标，将相关的治疗护理差距（即未采取行动弥补健康差距）归因于患者相关行为（即未取药或依从性低）或临床医生相关行为（即未开始/调整药物剂量）。我们举例说明了如何利用这些数据来管理萨特健康中心240,582名初级保健患者的血压（BP）、低密度脂蛋白胆固醇（LDL-C）和糖化血红蛋白（HbA1c）的健康和护理差距。高血压患者的健康差距患病率为44%，高脂血症患者为33%，糖尿病患者为57%。未取药的情况很常见；这种与患者相关的护理差距与健康差距高度相关（优势比（OR）：1.23 - 1.76）。与临床医生相关的治疗护理差距也很常见（高血压患者中为16%，高脂血症和糖尿病患者中分别为40%和27%），并且与高脂血症（OR = 5.8；95%置信区间：5.6 - 6.0）和糖尿病（OR = 5.7；95%置信区间：5.4 - 6.0）的健康差距密切相关。此外，相当一部分护理差距（9%至21%）尚不确定，这意味着我们缺乏证据将差距归因于患者或临床医生，从而阻碍了弥补差距的努力。
