Using EHRs to Evaluate Lipid Management Performance Metrics Can Be Problematic, Study Finds

Using electronic health records (EHRs) to determine why providers aren’t following lipid management performance measures can be problematic, according to an AHRQ-funded study in the October issue of the American Heart Journal. Researchers at the Duke Clinical Research Institute created a retrospective cohort of 3,779 patients with coronary artery disease from an academic medical center that uses EHRs. The charts of 300 patients chosen at random were reviewed to identify reasons for failure to adhere to lipid management performance measures. Researchers found that this type of assessment is possible, but accuracy is currently limited and may underestimate provider quality of care. Therefore, limitations such as poor specificity of claims data, inability to integrate with clinical data beyond institutional electronic health data, and incomplete information on medication use and intolerances need to be carefully considered before widespread implementation of automated care quality assessment. Select to access the journal abstract on PubMed®.

2013 Oct;166(4):701-8. doi: 10.1016/j.ahj.2013.07.024. Epub 2013 Sep 17.

The feasibility and accuracy of evaluating lipid management performance metrics using an electronic health record.

Danford CP, Navar-Boggan AM, Stafford J, McCarver C, Peterson ED, Wang TY.

Source

Duke Clinical Research Institute, Durham, NC. Electronic address: christopher.danford@duke.edu.

Abstract

BACKGROUND:

Over the past decade, electronic health records (EHRs) have emerged as a potential tool to assess quality of care; however, the feasibility and accuracy of EHRs to assess adherence to lipid management performance measures have not been evaluated.

METHODS:

We created a retrospective cohort of 3779 patients with coronary artery disease who were followed up in a cardiology clinic at an academic medical center using an EHR database. Of these 3779 patients, 300 randomly-selected charts were reviewed to identify reasons for failure to adhere to lipid management performance measures.

RESULTS:

Based on the EHR, a low-density lipoprotein cholesterol measurement was obtained in 73% of patients within the past 3 years; of which, 34% had low-density lipoprotein cholesterol levels ≥100 mg/dL and statin therapy had been prescribed in 88%. Manual chart review revealed that many of these apparent failures were actually false positives, due to inaccurate capture of indications and contraindications to lipid measurement and statin prescription, patient/provider treatment preferences, and external data sources.

CONCLUSIONS:

While it is possible to monitor adherence to lipid management performance measures using an EHR, the accuracy of this assessment is currently limited and may underestimate provider quality of care.
© 2013.