J Am Med Inform Assoc - Meaningful measurement: developing a measurement system to improve blood pressure control in patients with chronic kidney disease.

Tópicos

{ record(1888) medic(1808) patient(1693) }
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{ data(2317) use(1299) case(1017) }
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{ model(2656) set(1616) predict(1553) }
{ medic(1828) order(1363) alert(1069) }
{ ehr(2073) health(1662) electron(1139) }
{ activ(1138) subject(705) human(624) }
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{ motion(1329) object(1292) video(1091) }
{ problem(2511) optim(1539) algorithm(950) }
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{ imag(1947) propos(1133) code(1026) }
{ chang(1828) time(1643) increas(1301) }
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{ research(1085) discuss(1038) issu(1018) }
{ sequenc(1873) structur(1644) protein(1328) }
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{ time(1939) patient(1703) rate(768) }
{ patient(1821) servic(1111) care(1106) }
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{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
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{ drug(1928) target(777) effect(648) }
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Resumo

JECTIVES: To develop an electronic registry of patients with chronic kidney disease (CKD) treated in a nephrology practice in order to provide clinically meaningful measurement and population management to improve rates of blood pressure (BP) control.METHODS: We combined data from multiple electronic sources: the billing system, structured fields in the electronic health record (EHR), and free text physician notes using natural language processing (NLP). We also used point-of-care worksheets to capture clinical rationale.RESULTS: Nephrologist billing accurately identified patients with CKD. Using an algorithm that incorporated multiple BP readings increased the measured rate of control (130/80 mm Hg) from 37.1% to 42.3%. With the addition of NLP to capture BP readings from free text notes, the rate was 52.6%. Data from point-of-care worksheets indicated that in 52% of visits in which patients were identified as not having controlled BP, patients were actually at goal based on BP readings taken at home or on that day in the office.CONCLUSIONS: Building a method for clinically meaningful continuous performance measurement of BP control is possible, but will require data from multiple sources. Electronic measurement systems need to grow to be able to capture and process performance data from patients as well as in real-time from physicians.

Resumo Limpo

jectiv develop electron registri patient chronic kidney diseas ckd treat nephrolog practic order provid clinic meaning measur popul manag improv rate blood pressur bp controlmethod combin data multipl electron sourc bill system structur field electron health record ehr free text physician note use natur languag process nlp also use pointofcar worksheet captur clinic rationaleresult nephrologist bill accur identifi patient ckd use algorithm incorpor multipl bp read increas measur rate control mm hg addit nlp captur bp read free text note rate data pointofcar worksheet indic visit patient identifi control bp patient actual goal base bp read taken home day officeconclus build method clinic meaning continu perform measur bp control possibl will requir data multipl sourc electron measur system need grow abl captur process perform data patient well realtim physician

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