Abstract
Background: There is an increasing demand from local, state and national organizations to develop quality metric reporting in healthcare. At the same time there is both external and internal demand to not only report data, but to treat patients with multiple chronic diagnostic conditions in a cost effective manner. A model has been developed at Marshfield Clinic that offers a consistent, efficient, scalable and automated process to evaluate and report quality of care metrics and manage chronic disease populations. Data have been extracted from the electronic medical record (EMR), transformed into entity relationships, and loaded into an enterprise data warehouse to facilitate this model.
Methods: A systematic approach has been developed to standardize the measurement of both process and outcome quality measures using the following key steps:
defining and documenting quality of care metrics for a population,
identifying patients with the population of interest,
attributing those patients to a care provider,
evaluating and validating data, and
providing feedback in the form of storyboards and also in the form of an intervention list application that is managed by medical staff.
The first step clearly describes and documents the population of interest and quality of care metrics to be evaluated. The remaining four steps are programmatically automated for timely and efficient evaluation.
Results: Programs run nightly on a client PC that evaluates the health record for 61,000 unique patients with four possible chronic diagnostic conditions and up to 33 metrics. The average run time of this nightly program over a given month is 4 hours compared to a recent mandated manual chart abstraction of 418 records and 5 measures that took a total of 46 hours to complete. A report for diabetes mellitus shows improvement for low density lipoprotein control of 14% over a 2-year period.
Conclusions: This process demonstrates a model that is re-usable and scalable, providing an efficient delivery method of quality metric reporting. Quality of metric reporting using an EMR provides a consistent, standardized, and efficient feedback loop by having defined, retrievable data.
- Received September 11, 2008.
