Lund University School of Economics & Management, Lund, Sweden.
Futurum, Region Jönköping County, Jönköping, Sweden.
BMC Health Serv Res. 2024 Jan 4;24(1):33. doi: 10.1186/s12913-023-10407-9.
Digital applications that automatically extract information from electronic medical records and provide comparative visualizations of the data in the form of quality indicators to primary care practices may facilitate local quality improvement (QI). A necessary condition for such QI to work is that practices actively access the data. The purpose of this study was to explore the use of an application that visualizes quality indicators in Swedish primary care, developed by a profession-led QI initiative ("Primärvårdskvalitet"). We also describe the characteristics of practices that used the application more or less extensively, and the relationships between the intensity of use and changes in selected performance indicators.
We studied longitudinal data on 122 primary care practices' visits to pages (page views) in the application over a period up to 5 years. We compared high and low users, classified by the average number of monthly page views, with respect to practice and patient characteristics as well as baseline measurements of a subset of the performance indicators. We estimated linear associations between visits to pages with diabetes-related indicators and the change in measurements of selected diabetes indicators over 1.5 years.
Less than half of all practices accessed the data in a given month, although most practices accessed the data during at least one third of the observed months. High and low users were similar in terms of most studied characteristics. We found statistically significant positive associations between use of the diabetes indicators and changes in measurements of three diabetes indicators.
Although most practices in this study indicated an interest in the automated feedback reports, the intensity of use can be described as varying and on average limited. The positive associations between the use and changes in performance suggest that policymakers should increase their support of practices' QI efforts. Such support may include providing a formalized structure for peer group discussions of data, facilitating both understanding of the data and possible action points to improve performance, while maintaining a profession-led use of applications.
数字应用程序可以自动从电子病历中提取信息，并以质量指标的形式提供数据的比较可视化，从而为初级保健实践提供便利，促进当地质量改进（QI）。这种 QI 发挥作用的必要条件是实践积极访问数据。本研究的目的是探索使用一种由专业主导的 QI 计划（“Primärvårdskvalitet”）开发的可视化瑞典初级保健质量指标的应用程序。我们还描述了广泛或不广泛使用该应用程序的实践的特征，以及使用强度与选定绩效指标变化之间的关系。
我们研究了长达 5 年的 122 个初级保健实践访问应用程序页面（页面浏览量）的纵向数据。我们根据每月页面浏览量的平均值，将高和低用户进行了比较，比较了实践和患者特征以及选定绩效指标子集的基线测量值。我们估计了与糖尿病相关指标的页面访问次数与 1.5 年内选定糖尿病指标测量值变化之间的线性关联。
尽管大多数实践在至少三分之一的观察月份内都访问了数据，但在给定月份内，只有不到一半的实践访问了数据。高和低用户在大多数研究特征方面相似。我们发现使用糖尿病指标与测量值变化之间存在统计学上显著的正相关，其中三个糖尿病指标。
尽管本研究中的大多数实践都表示对自动化反馈报告感兴趣，但使用强度可以描述为变化且平均有限。使用与绩效变化之间的正相关关系表明，政策制定者应增加对实践 QI 工作的支持。这种支持可能包括为数据的同行小组讨论提供正式结构，促进对数据的理解和可能的改进绩效的切入点，同时保持应用程序的专业主导使用。
