Changes in Performance After Implementation of a Multifaceted Electronic-Health-Record-Based Quality Improvement System

Abstract

Implementation of a multifaceted QI intervention using EHR tools to improve quality measurement and the accuracy and timeliness of clinician feedback improved performance and/or accelerated the rate of improvement for multiple measures simultaneously.

Changes in Disparities Following the Implementation of a Health Information Technology-Supported Quality Improvement Initiative

“…Finally, the improvements in quality observed during the study period were greater than those expected based on temporal trends for most measures. 21 Nonetheless, this study has several strengths and provides important evidence regarding the effects of HIT-supported quality improvement initiatives on disparities in ambulatory care. This study evaluated a very common form of quality improvement-clinical decision support and provider feedback-delivered via a commercially available and widely used EHR system that aimed to improve a range of ambulatory quality indicators.…”

“…Since the practice-level quality measurements could be highly correlated from month to month, each time series model included the appropriate number of autoregressive error parameters. 21 The beta coefficient for the time variable was used to determine the modeled rate of change per year for each quality measure. The study was not limited to a cohort of patients who were continually eligible for a given quality measure at all time points throughout the study period (i.e., based on the dates of her two most recent visits to the practice, a woman might be eligible for the breast cancer screening measure on January 1, 2009 and ineligible for that measure on January 1, 2010).…”

“…Measures were assessed by querying the enterprise data warehouse, which contains stored data from the EHR, and details regarding the queries have been published elsewhere. 21 …”

“…The components of UPQUAL and the effects of the initiative on overall quality of care have been described elsewhere, 21 but to summarize, the intervention includes electronic point-of-care clinical reminders, decision support tools within the EHR to promote adherence to clinical guidelines, and regular provider feedback, which includes quarterly individual performance reports on all targeted measures and monthly lists of patients who are not prescribed essential medications (e.g., betablocker for a patient with a history of myocardial infarction). The quality improvement initiative was applied to all patients in the practice and was not specifically targeted or tailored based on patient race or other factors.…”

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

“…17 This study did not include patients with diabetes or established CVD, because ongoing quality improvement activity already addressed these conditions. 18 …”