会议论文详细信息
AMIA 2012 Annual Symposium
Electronic Quality Measurement Predicts Outcomesin Community Acquired Pneumonia
Shannon A. Sims ; MD ; PhD1 ; Jordan A. Dale ; MD1 ; Tricia J. Johnson ; PhD1
PID  :  129448
来源: CEUR
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【 摘 要 】
Using electronic medical data, we calculated emergency department physician performance and subsequentoutcomes on a measure used in the Centers for Medicare & Medicaid Services’ Physician Quality Reporting System.The measure assesses use of guideline recommended antibiotics for community acquired pneumonia. Physicians metmeasure criteria in 70.6% of cases at one institution. Among patients admitted to the hospital, measure compliantcases had a significantly shorter length of stay, lower costs and lower intensive care utilization than measurefailures. For measure failures admitted to the hospital, antibiotic treatment was adjusted to be measure compliantwithin 48 hours in 57.1% of cases. Use of electronic performance measurement for antibiotic treatment ofcommunity acquired pneumonia identified variations in physician performance. Measure compliance correlated withsignificantly improved patient outcomes and lower costs. BackgroundThe United States federal government and private payers are increasingly looking to valuebased purchasing toimprove the quality of care and reduce healthcare costs. One of the core tenets of value based purchasing isincentive payments for reporting performance data. Notable examples include the Meaningful Use IncentiveProgram and the Physician Quality Reporting System (formerly Physician Quality Reporting Initiative). Althoughthere is some data to suggest that pay for performance is an effective means of quality improvement, results aremixed.1One of the limitations of quality measurement in its current state is reliance on administrative (claims) data, which iscomprised of diagnoses, procedures, and demographic data about patient encounters. Secondary use of claims datafor measurement is often hindered by a dearth of clinical detail and the reality that coding is intended forreimbursement, not quality improvement. Additionally, not all services provided and relevant clinical data arecaptured in claims data.2 Finally, patient preferences are not available in administrative data, which are important foridentifying valid numerator exclusions.3Electronic Medical Records (EMRs) offer a potential solution to the limitations of administrative data.Comprehensive implementation of EMRs offers detailed clinical data to capture and analyze complex clinicalscenarios. Patient preferences and global reasons for measure exclusion—such as a patient receiving palliativemeasures only—can be used for performance calculation. Additionally, EMRs may also allow automatic capture ofquality measurement data without additional documentation from clinicians.4 However, robust testing is necessary toensure that electronic quality measurement is an improvement over the use of claims data.5Community acquired pneumonia (CAP) is a frequent topic of quality improvement because it is a common disease,has high costs, and is a frequent cause of mortality.6, 7 Additionally, adherence to antibiotic gui
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