Improving Blood Pressure Control Among Adults With CKD and Diabetes: Provider-Focused Quality Improvement Using Electronic Health Records

Background: Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control. Methods and Results: The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed ≈3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control (<140/90 mm Hg), which was 58% overall, and in the clinical processes relevant for BP control. For example, only 12% of patients with hypertension with a high BP measurement during an ambulatory visit received an order for a new antihypertensive medication. Conclusions: The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.

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Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records

British Journal of General Practice ◽

10.3399/bjgp19x704597 ◽

2019 ◽

Vol 69 (686) ◽

pp. e605-e611 ◽

Cited By ~ 2

Author(s):

Helen P Booth ◽

Arlene M Gallagher ◽

David Mullett ◽

Lucy Carty ◽

Shivani Padmanabhan ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Electronic Health Records ◽

Patient Care ◽

Scale Up ◽

Pilot Phase ◽

Electronic Health Record Data ◽

Health Records ◽

Patient Level ◽

Electronic Health

BackgroundQuality improvement (QI) is a priority for general practice, and GPs are expected to participate in and provide evidence of QI activity. There is growing interest in harnessing the potential of electronic health records (EHR) to improve patient care by supporting practices to find cases that could benefit from a medicines review.AimTo develop scalable and reproducible prescribing safety reports using patient-level EHR data.Design and settingUK general practices that contribute de-identified patient data to the Clinical Practice Research Datalink (CPRD).MethodA scoping phase used stakeholder consultations to identify primary care QI needs and potential indicators. QI reports containing real data were sent to 12 pilot practices that used Vision GP software and had expressed interest. The scale-up phase involved automating production and distribution of reports to all contributing practices that used both Vision and EMIS software systems. Benchmarking reports with patient-level case review lists for two prescribing safety indicators were sent to 457 practices in December 2017 following the initial scale-up (Figure 2).ResultsTwo indicators were selected from the Royal College of General Practitioners Patient Safety Toolkit following stakeholder consultations for the pilot phase involving 12 GP practices. Pilot phase interviews showed that reports were used to review individual patient care, implement wider QI actions in the practice, and for appraisal and revalidation.ConclusionElectronic health record data can be used to provide standardised, reproducible reports that can be delivered at scale with minimal resource requirements. These can be used in a national QI initiative that impacts directly on patient care.

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Electronic Health Records as Valuable Data Sources in the Health Care Quality Improvement Process

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392819852879 ◽

2019 ◽

Vol 6 ◽

pp. 233339281985287 ◽

Cited By ~ 1

Author(s):

Katja Wikström ◽

Maija Toivakka ◽

Päivi Rautiainen ◽

Hilkka Tirkkonen ◽

Teppo Repo ◽

...

Keyword(s):

Quality Improvement ◽

Early Detection ◽

Electronic Health Records ◽

Regional Differences ◽

Health Care Quality ◽

Data Retrieval ◽

Care Quality ◽

Health Records ◽

Valuable Data ◽

Electronic Health

Background: In North Karelia, Finland, the regional electronic health records (EHRs) enable flexible data retrieval and area-level analyses. The aim of this study was to assess the early detection of type 2 diabetes (T2D) in the region and to evaluate the performed activities in order to improve the processes between the years 2012 and 2017. Methods: Patients with T2D were identified from the EHRs using the ICD-10 codes registered during any visit to either primary or specialized care. The prevalence of T2D was calculated for the years 2012, 2015, and 2017 on the municipality level. The number of people found in the EHRs with diabetes was compared with the number found in the national register of medication reimbursement rights. Results: In 2012, the age-adjusted prevalence of T2D in North Karelia varied considerably between municipalities (5.5%-8.6%). These differences indicate variation in the processes of early diagnosis. The findings were discussed in the regional network of health professionals treating patients with T2D, resulting in sharing experiences and best practices. In 2017, the differences had notably diminished, and in most municipalities, the prevalence exceeded 8%. The regional differences in the prevalence and their downward trend were observed both in the EHRs and in the medication reimbursement rights register. Conclusion: Clear differences in the prevalence of T2D were detected between municipalities. After visualizing these differences and providing information for the professionals, the early detection of T2D improved and the regional differences decreased. The EHRs are a valuable data source for knowledge-based management and quality improvement.

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