Smith Maureen A, Gigot Matthew, Harburn Abbey, Bednarz Lauren, Curtis Katherine, Mathew Jomol, Farrar-Edwards Dorothy
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
J Clin Transl Sci. 2023 Feb 1;7(1):e54. doi: 10.1017/cts.2022.521. eCollection 2023.
Within Wisconsin, our residents experience some of the worst health disparities in the nation. Public reporting on disparities in the quality of care is important to achieving accountability for reducing disparities over time and has been associated with improvements in care. Disparities reporting using statewide electronic health records (EHR) data would allow efficient and regular reporting, but there are significant challenges with missing data and data harmonization. We report our experience in creating a statewide, centralized EHR data repository to support health systems in reducing health disparities through public reporting. We partnered with the Wisconsin Collaborative for Healthcare Quality (the "Collaborative"), which houses patient-level EHR data from 25 health systems including validated metrics of healthcare quality. We undertook a detailed assessment of potential disparity indicators (race and ethnicity, insurance status and type, and geographic disparity). Challenges for each indicator are described, with solutions encompassing internal (health system) harmonization, central (Collaborative) harmonization, and centralized data processing. Key lessons include engaging health systems in identifying disparity indicators, aligning with system priorities, measuring indicators already collected in the EHR to minimize burden, and facilitating workgroups with health systems to build relationships, improve data collection, and develop initiatives to address disparities in healthcare.
在威斯康星州，我们的居民面临着全国最严重的一些健康差异问题。公开报告医疗质量差异对于实现长期减少差异的问责制很重要，并且与医疗改善相关。利用全州范围的电子健康记录（EHR）数据进行差异报告将实现高效且定期的报告，但在数据缺失和数据协调方面存在重大挑战。我们报告了我们创建全州范围的集中式EHR数据存储库的经验，以支持医疗系统通过公开报告减少健康差异。我们与威斯康星州医疗质量合作组织（“合作组织”）合作，该组织存储了来自25个医疗系统的患者级EHR数据，包括经过验证的医疗质量指标。我们对潜在的差异指标（种族和族裔、保险状况和类型以及地理差异）进行了详细评估。描述了每个指标面临的挑战，解决方案包括内部（医疗系统）协调、中央（合作组织）协调和集中式数据处理。关键经验教训包括让医疗系统参与确定差异指标、与系统优先事项保持一致、衡量EHR中已经收集的指标以减轻负担，以及促进与医疗系统的工作组建立关系、改善数据收集并制定解决医疗保健差异的举措。
