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Guideline Utilising practice management system data for quality improvement in use of blood pressure lowering medications in general practice. 2008
Warren J, Gaikwad R, Mabotuwana T, Kennelly J, Kenealy T. · Section for Epidemiology and Biostatistics / Department of Computer Science, University of Auckland, Auckland, New Zealand. · N Z Med J. · Pubmed #19079437 No free full text.
Abstract: AIM: To assess use of Electronic Medical Records (EMRs) to identify patient cases for potential quality improvement in use of blood pressure-lowering medications in general practice. SETTING: One metropolitan general practice in Auckland with a high proportion of Pacific patients. PARTICIPANTS: Patients registered as regular patients with the practice; classified within the previous 5 years as having hypertension; with at least one prescription for antihypertensive medication in the year prior to the evaluation period of 9 May to 8 November 2007. INTERVENTION: Iterative discussion of quality improvement opportunities and review of EMRs with a panel of practice clinicians to identify agreed quality indicators based on EMR data. This resulted in a set of eight evidence-based criteria for patients classified with hypertension, implemented as database queries, which identify cases for potential quality improvement. The panel conducted blind assessment of antihypertensive therapy on a sample of 20 cases matching at least one criterion and 20 cases that met no criterion; the case classifications based on the database queries were then revealed for direct comment and consideration by the panel. RESULTS: Of 517 eligible patients, 209 (40.4%) met one or more of the eight criteria. Of these 209, 110 (21.3%) met only criteria related to persistence of medication possession and/or blood pressure recording. After assessment of the 40-patient sample by the practice GPs, the eight criteria taken as a whole had a Positive Predictive Value of 70% (95% CI 46-88%) and Negative Predictive Value of 70% for clinician assessment of suboptimal therapy and/or process. CONCLUSION: EMRs can provide moderately reliable identification of patients with suboptimal management of blood pressure in general practice. It should be noted, however, that the complexity of required query formulation is substantial with current tools. Identification of patients with poor persistence of antihypertensive therapy is the most promising outcome for follow-up investigation. The study needs to be replicated in a range of different practice settings.
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Article The TAR model: use of therapeutic state transitions for quality assurance reporting in chronic disease management. 2007
Gaikwad R, Warren J, Kenealy T. · Department of Computer Science, The University of Auckland, New Zealand. · Stud Health Technol Inform. · Pubmed #17911839 No free full text.
Abstract: Chronic disease management represents one of the challenges for health informatics and demands the appropriate application of information technology for improved patient care. This paper presents an approach to quality assurance reporting wherein the recommendations of evidence-based clinical practice guidelines are considered in the context of empirical therapeutic state-transitions (in terms of changes in individual patient prescriptions over time). We apply a Transition-based Audit Report (TAR) model to antihypertensive prescribing and related data as stored in a New Zealand General Practice Management System database. The results provide a set of quality indicators and specific patient cohorts for potential practice quality improvement with strong linkage to the selected guidelines and observed practice patterns. We see the TAR model primarily as a tool to enable internal quality improvement efforts, but also to be of relevance for focusing pay-for-performance programs.
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