Abstract
BackgroundDirect feedback on quality of care is one of the key features of a learning health care system (LHS), enabling health care professionals to improve upon the routine clinical care of their patients during practice.ObjectiveThis study aimed to evaluate the potential of routine care data extracted from electronic health records (EHRs) in order to obtain reliable information on low-density lipoprotein cholesterol (LDL-c) management in cardiovascular disease (CVD) patients referred to a tertiary care center.MethodsWe extracted all LDL-c measurements from the EHRs of patients with a history of CVD referred to the University Medical Center Utrecht. We assessed LDL-c target attainment at the time of referral and per year. In patients with multiple measurements, we analyzed LDL-c trajectories, truncated at 6 follow-up measurements. Lastly, we performed a logistic regression analysis to investigate factors associated with improvement of LDL-c at the next measurement.ResultsBetween February 2003 and December 2017, 250,749 LDL-c measurements were taken from 95,795 patients, of whom 23,932 had a history of CVD. At the time of referral, 51% of patients had not reached their LDL-c target. A large proportion of patients (55%) had no follow-up LDL-c measurements. Most of the patients with repeated measurements showed no change in LDL-c levels over time: the transition probability to remain in the same category was up to 0.84. Sequence clustering analysis showed more women (odds ratio 1.18, 95% CI 1.07-1.10) in the cluster with both most measurements off target and the most LDL-c measurements furthest from the target. Timing of drug prescription was difficult to determine from our data, limiting the interpretation of results regarding medication management.ConclusionsRoutine care data can be used to provide feedback on quality of care, such as LDL-c target attainment. These routine care data show high off-target prevalence and little change in LDL-c over time. Registrations of diagnosis; follow-up trajectory, including primary and secondary care; and medication use need to be improved in order to enhance usability of the EHR system for adequate feedback.
Highlights
At present, quality of care is generally evaluated in clinical trials or in expensive and laborious cross-sectional studies, such as the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) or SUrvey of Risk Factor management (SURF) initiatives, which evaluated target attainment of low-density lipoprotein cholesterol (LDL-c) [1,2,3]
Registrations of diagnosis; follow-up trajectory, including primary and secondary care; and medication use need to be improved in order to enhance usability of the electronic health record EUROASPIRE (EHR) system for adequate feedback
Quality of care is generally evaluated in clinical trials or in expensive and laborious cross-sectional studies, such as the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) or SUrvey of Risk Factor management (SURF) initiatives, which evaluated target attainment of low-density lipoprotein cholesterol (LDL-c) [1,2,3]
Summary
Quality of care is generally evaluated in clinical trials or in expensive and laborious cross-sectional studies, such as the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) or SUrvey of Risk Factor management (SURF) initiatives, which evaluated target attainment of low-density lipoprotein cholesterol (LDL-c) [1,2,3] These studies estimated the proportion of LDL-c target attainment and showed the magnitude of the clinical problem on a patient population level but did not provide feedback on an individual patient level. Routine care data better reflects the real-world situation and is less affected by nonresponse This improves generalizability of results and makes routine care data more suitable for prevalence questions as compared to clinical trial or dedicated cohort data [4]. Direct feedback on quality of care is one of the key features of a learning health care system (LHS), enabling health care professionals to improve upon the routine clinical care of their patients during practice
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