Title

Quality measurement of medication monitoring in the "meaningful use" era

Student Author(s)

Shira H. Fischer

GSBS Program

Clinical & Population Health Research Program

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine

Date

9-10-2011

Document Type

Article

Medical Subject Headings

Drug Monitoring; Pharmaceutical Preparations; Cardiovascular Agents; Safety Management; Quality Indicators, Health Care

Disciplines

Health Services Research | Life Sciences | Medicine and Health Sciences

Abstract

Objectives: While the 2011 implementation of "meaningful use" legislation for certified electronic health records (EHRs) promises to change quality reporting by overcoming data capture issues affecting quality measurement, the magnitude of this effect is unclear. We compared the measured quality of laboratory monitoring of Healthcare Effectiveness Data and Information Set (HEDIS) medications based on specifications that (1) include and exclude patients hospitalized in the measurement year and (2) use physician test orders and patient test completion.

Study Design: Cross-sectional study.

Methods: Among patients 18 years and older in a large multispecialty group practice utilizing a fully implemented EHR between January 1, 2008, and July 31, 2008, we measured the prevalence of ordering and completion of laboratory tests monitoring HEDIS medications (cardiovascular drugs [angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, digoxin, and diuretics] and anticonvulsants [carbamazepine, phenobarbital, phenytoin, and valproic acid]).

Results: Measures excluding hospitalized patients were not statistically significantly different from measures including hospitalized patients, except for digoxin, but this difference was not clinically significant. The prevalence of appropriate monitoring based on test orders typically captured in the EHR was statistically significantly higher than the prevalence based on claims-based test completions for cardiovascular drugs.

Conclusions: HEDIS quality metrics based on data typically collected from claims undermeasured quality of medication monitoring compared to EHR data. The HEDIS optional specification excluding hospitalized patients from the monitoring measure does not have a significant impact on reported quality. Integration of EHR data into quality measurement may significantly change some organizations' reported quality of care.

Rights and Permissions

Citation: Am J Manag Care. 2011 Sep;17(9):633-7. Link to article on publisher's website

Related Resources

Link to Article in PubMed