Development and validation of electronic quality measures to assess care for patients with transient ischemic attack and minor ischemic stroke

Dawn M. Bravata, Laura J. Myers, Eric Cheng, Mathew Reeves, Fitsum Baye, Zhangsheng Yu, Teresa Damush, Edward J. Miech, Jason Sico, Michael Phipps, Alan Zillich, Jason M Johanning, Seemant Chaturvedi, Curt Austin, Jared Ferguson, Bailey Maryfield, Kathy Snow, Susan Ofner, Glenn Graham, Rachel RhudeLinda S. Williams, Greg Arling

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background-Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data. Methods and Results-A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified. We constructed 31 eQMs based on existing quality measures. Chart review was the criterion standard for validating the eQMs. To evaluate eQMs in terms of eligibility, we calculated the proportion of patients who were genuinely not eligible to receive a process (based on chart review) and who were correctly identified as not eligible by the EHR data (specificity). To assess eQMs about classification of whether patients received a process, we calculated the proportion of patients who actually received the process (based on chart review) and who were classified correctly by the EHR data as passing (sensitivity). Seven hundred sixty-Three patients were included. About eligibility, specificity varied from 25% (brain imaging; carotid imaging) to 99% (anticoagulation quality). About pass rates, sensitivity varied from 30% (antihypertensive class) to 100% (coronary risk assessment; international normalized ratio measured). The 16 eQMs with ≥70% specificity in eligibility and ≥70% sensitivity in pass rates included coronary risk assessment, international normalized ratio measured, HbA1c measurement, speech language pathology consultation, anticoagulation for atrial fibrillation, discharge on statin, lipid management, neurology consultation, Holter, deep vein thrombosis prophylaxis, oral hypoglycemic intensification, cholesterol medication intensification, antihypertensive intensification, antihypertensive class, carotid stenosis intervention, and substance abuse referral for alcohol. Conclusions-It is feasible to construct valid eQMs for processes of transient ischemic attack and minor ischemic stroke care. Healthcare systems with EHRs should consider using electronic data to evaluate care for their patients with transient ischemic attack and to complement and expand quality measurement programs currently focused on patients with stroke.

Original languageEnglish (US)
Article numbere003157
JournalCirculation: Cardiovascular Quality and Outcomes
Volume10
Issue number9
DOIs
StatePublished - Jun 1 2017

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Transient Ischemic Attack
Patient Care
Electronic Health Records
Stroke
Antihypertensive Agents
International Normalized Ratio
Referral and Consultation
Speech-Language Pathology
Veterans Health
Hydroxymethylglutaryl-CoA Reductase Inhibitors
United States Department of Veterans Affairs
Process Assessment (Health Care)
Quality of Health Care
Carotid Stenosis
Health Facilities
Neurology
Hypoglycemic Agents
Neuroimaging
Venous Thrombosis
Atrial Fibrillation

Keywords

  • Ischemic attack
  • Sensitivity and specificity
  • Stroke
  • Transient
  • electronic health records

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Development and validation of electronic quality measures to assess care for patients with transient ischemic attack and minor ischemic stroke. / Bravata, Dawn M.; Myers, Laura J.; Cheng, Eric; Reeves, Mathew; Baye, Fitsum; Yu, Zhangsheng; Damush, Teresa; Miech, Edward J.; Sico, Jason; Phipps, Michael; Zillich, Alan; Johanning, Jason M; Chaturvedi, Seemant; Austin, Curt; Ferguson, Jared; Maryfield, Bailey; Snow, Kathy; Ofner, Susan; Graham, Glenn; Rhude, Rachel; Williams, Linda S.; Arling, Greg.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 10, No. 9, e003157, 01.06.2017.

Research output: Contribution to journalArticle

Bravata, DM, Myers, LJ, Cheng, E, Reeves, M, Baye, F, Yu, Z, Damush, T, Miech, EJ, Sico, J, Phipps, M, Zillich, A, Johanning, JM, Chaturvedi, S, Austin, C, Ferguson, J, Maryfield, B, Snow, K, Ofner, S, Graham, G, Rhude, R, Williams, LS & Arling, G 2017, 'Development and validation of electronic quality measures to assess care for patients with transient ischemic attack and minor ischemic stroke', Circulation: Cardiovascular Quality and Outcomes, vol. 10, no. 9, e003157. https://doi.org/10.1161/CIRCOUTCOMES.116.003157
Bravata, Dawn M. ; Myers, Laura J. ; Cheng, Eric ; Reeves, Mathew ; Baye, Fitsum ; Yu, Zhangsheng ; Damush, Teresa ; Miech, Edward J. ; Sico, Jason ; Phipps, Michael ; Zillich, Alan ; Johanning, Jason M ; Chaturvedi, Seemant ; Austin, Curt ; Ferguson, Jared ; Maryfield, Bailey ; Snow, Kathy ; Ofner, Susan ; Graham, Glenn ; Rhude, Rachel ; Williams, Linda S. ; Arling, Greg. / Development and validation of electronic quality measures to assess care for patients with transient ischemic attack and minor ischemic stroke. In: Circulation: Cardiovascular Quality and Outcomes. 2017 ; Vol. 10, No. 9.
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AU - Bravata, Dawn M.

AU - Myers, Laura J.

AU - Cheng, Eric

AU - Reeves, Mathew

AU - Baye, Fitsum

AU - Yu, Zhangsheng

AU - Damush, Teresa

AU - Miech, Edward J.

AU - Sico, Jason

AU - Phipps, Michael

AU - Zillich, Alan

AU - Johanning, Jason M

AU - Chaturvedi, Seemant

AU - Austin, Curt

AU - Ferguson, Jared

AU - Maryfield, Bailey

AU - Snow, Kathy

AU - Ofner, Susan

AU - Graham, Glenn

AU - Rhude, Rachel

AU - Williams, Linda S.

AU - Arling, Greg

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N2 - Background-Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data. Methods and Results-A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified. We constructed 31 eQMs based on existing quality measures. Chart review was the criterion standard for validating the eQMs. To evaluate eQMs in terms of eligibility, we calculated the proportion of patients who were genuinely not eligible to receive a process (based on chart review) and who were correctly identified as not eligible by the EHR data (specificity). To assess eQMs about classification of whether patients received a process, we calculated the proportion of patients who actually received the process (based on chart review) and who were classified correctly by the EHR data as passing (sensitivity). Seven hundred sixty-Three patients were included. About eligibility, specificity varied from 25% (brain imaging; carotid imaging) to 99% (anticoagulation quality). About pass rates, sensitivity varied from 30% (antihypertensive class) to 100% (coronary risk assessment; international normalized ratio measured). The 16 eQMs with ≥70% specificity in eligibility and ≥70% sensitivity in pass rates included coronary risk assessment, international normalized ratio measured, HbA1c measurement, speech language pathology consultation, anticoagulation for atrial fibrillation, discharge on statin, lipid management, neurology consultation, Holter, deep vein thrombosis prophylaxis, oral hypoglycemic intensification, cholesterol medication intensification, antihypertensive intensification, antihypertensive class, carotid stenosis intervention, and substance abuse referral for alcohol. Conclusions-It is feasible to construct valid eQMs for processes of transient ischemic attack and minor ischemic stroke care. Healthcare systems with EHRs should consider using electronic data to evaluate care for their patients with transient ischemic attack and to complement and expand quality measurement programs currently focused on patients with stroke.

AB - Background-Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data. Methods and Results-A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified. We constructed 31 eQMs based on existing quality measures. Chart review was the criterion standard for validating the eQMs. To evaluate eQMs in terms of eligibility, we calculated the proportion of patients who were genuinely not eligible to receive a process (based on chart review) and who were correctly identified as not eligible by the EHR data (specificity). To assess eQMs about classification of whether patients received a process, we calculated the proportion of patients who actually received the process (based on chart review) and who were classified correctly by the EHR data as passing (sensitivity). Seven hundred sixty-Three patients were included. About eligibility, specificity varied from 25% (brain imaging; carotid imaging) to 99% (anticoagulation quality). About pass rates, sensitivity varied from 30% (antihypertensive class) to 100% (coronary risk assessment; international normalized ratio measured). The 16 eQMs with ≥70% specificity in eligibility and ≥70% sensitivity in pass rates included coronary risk assessment, international normalized ratio measured, HbA1c measurement, speech language pathology consultation, anticoagulation for atrial fibrillation, discharge on statin, lipid management, neurology consultation, Holter, deep vein thrombosis prophylaxis, oral hypoglycemic intensification, cholesterol medication intensification, antihypertensive intensification, antihypertensive class, carotid stenosis intervention, and substance abuse referral for alcohol. Conclusions-It is feasible to construct valid eQMs for processes of transient ischemic attack and minor ischemic stroke care. Healthcare systems with EHRs should consider using electronic data to evaluate care for their patients with transient ischemic attack and to complement and expand quality measurement programs currently focused on patients with stroke.

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