This article and any supplementary material should be cited as follows: Ganz DA, Almeida S, Roth CP, Reuben DB, Wenger NS. Can structured data fields accurately measure quality of care? The example of falls. J Rehabil Res Dev. 2012; 49(9):1411–20. http://dx.doi.org/10.1682/JRRD.2011.09.0184
Slideshow ProjectDOI:10.1682/JRRD.2011.09.0184JSP
Can structured data fields accurately measure quality of care?
The example of falls
David A. Ganz, MD, PhD; Shone Almeida, BS; Carol P. Roth, RN, MPH; David B. Reuben, MD;
Neil S. Wenger, MD, MPH
This article and any supplementary material should be cited as follows: Ganz DA, Almeida S, Roth CP, Reuben DB, Wenger NS. Can structured data fields accurately measure quality of care? The example of falls. J Rehabil Res Dev. 2012; 49(9):1411–20. http://dx.doi.org/10.1682/JRRD.2011.09.0184
Slideshow ProjectDOI:10.1682/JRRD.2011.09.0184JSP
• Aim– Determine whether quality of care can be accurately
estimated from structured (non-free-text) fields in structured visit note (SVN) when SVN is part of routine documentation.
• Relevance– By automating collection of data elements, electronic
health records may simplify process of measuring quality of medical care.
This article and any supplementary material should be cited as follows: Ganz DA, Almeida S, Roth CP, Reuben DB, Wenger NS. Can structured data fields accurately measure quality of care? The example of falls. J Rehabil Res Dev. 2012; 49(9):1411–20. http://dx.doi.org/10.1682/JRRD.2011.09.0184
Slideshow ProjectDOI:10.1682/JRRD.2011.09.0184JSP
Method– Used data from quality
improvement initiative in primary care medical groups.• Determined whether quality of
care for falls/fear of falling in outpatients aged 75+ could be accurately measured from codable data in SVN.
– Criterion standard was traditional medical record review by trained abstractors.
Sample SVN.
This article and any supplementary material should be cited as follows: Ganz DA, Almeida S, Roth CP, Reuben DB, Wenger NS. Can structured data fields accurately measure quality of care? The example of falls. J Rehabil Res Dev. 2012; 49(9):1411–20. http://dx.doi.org/10.1682/JRRD.2011.09.0184
Slideshow ProjectDOI:10.1682/JRRD.2011.09.0184JSP
Results• 215 patient records reviewed.– SVN in 54% of charts within 3 mo of patients
identified as having falls or fear of falling. • Automated algorithm based on codable data:– Reliability was at least good (kappa ≥ 0.61) vs. full
medical record review for 3 care processes (ortho-static vital signs, vision test/eye examination, and home safety evaluation) recommended for patients with 2 falls or 1 fall with injury in past year.
– Routinely underestimated quality of care.
This article and any supplementary material should be cited as follows: Ganz DA, Almeida S, Roth CP, Reuben DB, Wenger NS. Can structured data fields accurately measure quality of care? The example of falls. J Rehabil Res Dev. 2012; 49(9):1411–20. http://dx.doi.org/10.1682/JRRD.2011.09.0184
Slideshow ProjectDOI:10.1682/JRRD.2011.09.0184JSP
Conclusion
• Structured data should be used cautiously for measurement of quality of care and will likely underestimate actual care delivery.
• Degree to which structured data accurately represent underlying care delivered varies according to type of care process.
• Quality measurement systems using automated data will continue to benefit from validation against full medical record review.
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