The effect of automated audit and feedback on data completeness in the electronic health record of the general physician: protocol for a cluster randomized controlled trial

Bulck, Steve Van den; Burghgraeve, Tine De; Raat, W.K. de; Mamouris, Pavlos; Coursier, Patrick; Vankrunkelsven, Patrik; Goderis, Geert; Hermens, Rosella; Pottelbergh, Gijs Van; Vaes, Bert

doi:10.1186/s13063-021-05259-9

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…For example, it is not clear how circumstantial factors (such as a lockdown) could influence the quality of registration in the EHR. However, the resulting bias is minimized by accounting for practice differences in the analysis and steps have been taken to improve data completeness [ 42 ]. We collect data from all patients visiting the participating practices, but this does not guarantee that these patients will be a representative sample for the Flemish population.…”

Section: Discussionmentioning

confidence: 99%

The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study

et al. 2022

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Introduction The Covid-19 pandemic had a tremendous impact on healthcare but uncertainty remains about the extent to which primary care provision was affected. Therefore, this paper aims to assess the impact on primary care provision and the evolution of the incidence of disease during the first year of the Covid-19 pandemic in Flanders (Belgium). Methods Care provision was defined as the number of new entries added to a patient’s medical history. Pre-pandemic care provision (February 1, 2018–January 31, 2020) was compared with care provision during the pandemic (February 1, 2020-January 31, 2021). A large morbidity registry (Intego) was used. Regression models compared the effect of demographic characteristics on care provision and on acute and chronic diagnoses incidence both prior and during the pandemic. Results During the first year of the Covid-19 pandemic, overall care provision increased with 9.1% (95%CI 8.5%;9.6%). There was an increase in acute diagnoses of 5.1% (95%CI 4.2%;6.0%) and a decrease in the selected chronic diagnoses of 12.8% (95% CI 7.0%;18.4%). Obesity was an exception with an overall incidence increase. The pandemic led to strong fluctuations in care provision that were not the same for all types of care and all demographic groups in Flanders. Relative to other groups in the population, the pandemic caused a reduction in care provision for children aged 0–17 year and patients from a lower socio-economic situation. Conclusion This paper strengthened the claim that Covid-19 should be considered as a syndemic instead of a pandemic. During the first Covid-19 year, overall care provision and the incidence of acute diagnoses increased, whereas chronic diseases’ incidence decreased, except for obesity diagnoses which increased. More granular, care provision and chronic diseases’ incidence decreased during the lockdowns, especially for people with a lower socio-economic status. After the lockdowns they both returned to baseline.

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Section: Discussionmentioning

confidence: 99%

The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study

et al. 2022

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“…Data were collected from 105 practices that are individually responsible for delivering qualitative and complete data. Possible registration errors were minimized by accounting for interpractice differences, and steps have been taken to improve data completeness [ 33 ]. However, there might be a general underregistration of mental health problems in general practice (especially subclinical problems) that we were unable to pick up due to them not being coded.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on the Registration and Care Provision of Mental Health Problems in General Practice: Registry-Based Study

Vandamme

Beerten

Crèvecoeur

et al. 2023

JMIR Public Health Surveill

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Background The impact of the COVID-19 pandemic on mental health in general practice remains uncertain. Several studies showed an increase in terms of mental health problems during the pandemic. In Belgium, especially during the first waves of the pandemic, access to general practice was limited. Specifically, it is unclear how this impacted not only the registration of mental health problems itself but also the care for patients with an existing mental health problem. Objective This study aimed to know the impact of the COVID-19 pandemic on (1) the incidence of newly registered mental health problems and (2) the provision of care for patients with mental health problems in general practice, both using a pre–COVID-19 baseline. Methods The prepandemic volume of provided care (care provision) for patients with mental health problems was compared to that from 2020-2021 by using INTEGO, a Belgian general practice morbidity registry. Care provision was defined as the total number of new registrations in a patient’s electronic medical record. Regression models evaluated the association of demographic factors and care provision in patients with mental health problems, both before and during the pandemic. Results During the COVID-19 pandemic as compared to before the COVID-19 pandemic, the incidence of registered mental health problems showed a fluctuating course, with a sharp drop in registrations during the first wave. Registrations for depression and anxiety increased, whereas the incidence of registered eating disorders, substance abuse, and personality problems decreased. During the 5 COVID-19 waves, the overall incidence of registered mental health problems dropped during the wave and rose again when measures were relaxed. A relative rise of 8.7% and 40% in volume of provided care, specifically for patients with mental health problems, was seen during the first and second years of the COVID-19 pandemic, respectively. Care provision for patients with mental health problems was higher in older patients, male patients, patients living in center cities (centrumsteden), patients with lower socioeconomic status (SES), native Belgian patients, and patients with acute rather than chronic mental health problems. Compared to prepandemic care provision, a reduction of 10% was observed in people with a low SES. Conclusions This study showed (1) a relative overall increase in the registrations of mental health problems in general practice and (2) an increase in care provision for patients with mental health problems in the first 2 years of the COVID-19 pandemic. Low SES remained a determining factor for more care provision, but care provision dropped significantly in people with mental health problems with a low SES. Our findings suggest that the pandemic in Belgium was also largely a “syndemic,” affecting different layers of the population disproportionately.

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“…Furthermore, natural language processing technologies have shown promise in automating data extraction of clinical notes, ranging from radiology reports to discharge summaries 39. In the EHRs of academic health centres, patients are assigned to staff physicians such that data-driven metrics are already being generated to support audit and feedback, physician report card initiatives, and broader quality improvement efforts 17 40 41. However, the transient nature of learners in our health system creates unique challenges when trying to link patient data to resident care, especially in the inpatient setting.…”

Section: Introductionmentioning

confidence: 99%

Methodology paper for the General Medicine Inpatient Initiative Medical Education Database (GEMINI MedED): a retrospective cohort study of internal medicine resident case-mix, clinical care and patient outcomes

Lam

Tang

Lalwani³

et al. 2022

BMJ Open

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IntroductionUnwarranted variation in patient care among physicians is associated with negative patient outcomes and increased healthcare costs. Care variation likely also exists for resident physicians. Despite the global movement towards outcomes-based and competency-based medical education, current assessment strategies in residency do not routinely incorporate clinical outcomes. The widespread use of electronic health records (EHRs) may enable the implementation of in-training assessments that incorporate clinical care and patient outcomes.Methods and analysisThe General Medicine Inpatient Initiative Medical Education Database (GEMINI MedED) is a retrospective cohort study of senior residents (postgraduate year 2/3) enrolled in the University of Toronto Internal Medicine (IM) programme between 1 April 2010 and 31 December 2020. This study focuses on senior IM residents and patients they admit overnight to four academic hospitals. Senior IM residents are responsible for overseeing all overnight admissions; thus, care processes and outcomes for these clinical encounters can be at least partially attributed to the care they provide. Call schedules from each hospital, which list the date, location and senior resident on-call, will be used to link senior residents to EHR data of patients admitted during their on-call shifts. Patient data will be derived from the GEMINI database, which contains administrative (eg, demographic and disposition) and clinical data (eg, laboratory and radiological investigation results) for patients admitted to IM at the four academic hospitals. Overall, this study will examine three domains of resident practice: (1) case-mix variation across residents, hospitals and academic year, (2) resident-sensitive quality measures (EHR-derived metrics that are partially attributable to resident care) and (3) variations in patient outcomes across residents and factors that contribute to such variation.Ethics and disseminationGEMINI MedED was approved by the University of Toronto Ethics Board (RIS#39339). Results from this study will be presented in academic conferences and peer-reviewed journals.

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The effect of automated audit and feedback on data completeness in the electronic health record of the general physician: protocol for a cluster randomized controlled trial

Cited by 6 publications

References 36 publications

The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study

The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study

The Impact of the COVID-19 Pandemic on the Registration and Care Provision of Mental Health Problems in General Practice: Registry-Based Study

Methodology paper for the General Medicine Inpatient Initiative Medical Education Database (GEMINI MedED): a retrospective cohort study of internal medicine resident case-mix, clinical care and patient outcomes

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