Data extraction from electronic health records (EHRs) for quality measurement of the physical therapy process: comparison between EHR data and survey data (original) (raw)
Related papers
Evaluating quality indicators for physical therapy in primary care
Objective. To evaluate measurement properties of a set of public quality indicators on physical therapy. Design. An observational study with web-based collected survey data (2009 and 2010). Setting. Dutch primary care physical therapy practices. Participants. In 3743 physical therapy practices, 11 274 physical therapists reporting on 30 patients each. Main Outcome Measure(s). Eight quality indicators were constructed: screening and diagnostics (n = 2), setting target aim and subsequent of intervention (n = 2), administrating results (n = 1), global outcome measures (n = 2) and patient’s treatment agreement (n = 1). Measurement properties on content and construct validity, reproducibility, floor and ceiling effects and interpretability of the indicators were assessed using comparative statistics and multilevel modeling. Results. Content validity was acceptable. Construct validity (using known group techniques) of two outcome indicators was acceptable; hypotheses on age, gender and chronic vs. acute care were confirmed. For the whole set of indicators reproducibility was approximated by correlation of 2009 and 2010 data and rated moderately positive (Spearman’s ρ between 0.3 and 0.42 at practice level) and interpretability as acceptable, as distinguishing between patient groups was possible. Ceiling effects were assessed negative as they were high to extremely high (30% for outcome indicator 6–95% for administrating results). Conclusion. Weaknesses in data collection should be dealt with to reduce bias and to reduce ceiling effects by randomly extracting data from electronic medical records. More specificity of the indicators seems to be needed, and can be reached by focusing on most prevalent conditions, thus increasing usability of the indicators to improve quality of care. Keywords: quality indicators, physical therapy, measurement properties, measurement of quality
Physical Therapy, 2008
Background and Purpose Improving clinical outcomes requires continuous measurement and interpretation in conjunction with treatment process and patient characteristics. The purposes of this study were: (1) to describe implementation and integration of electronic functional status outcomes into an electronic health record (EHR) for the promotion of clinical practice improvement processes and (2) to examine the effect of ongoing outcomes data collection in a large physical therapy service in relation to patient and clinic burden. Subjects Data were examined from 21,523 adult patients (mean age=50.6 years, SD=16.3, range=18–99; 58.9% women, 41.1% men) referred for physical therapist management of neuromusculoskeletal disorders. Methods Process and patient characteristic data were entered into the EHR. Outcomes data collected using computerized adaptive testing technology in 11 outpatient clinics were integrated into the EHR. The effect of data collection was assessed by measuring the p...
Electronic Clinical Records for Physiotherapists
2006
Purpose: This pilot study compared traditional (paper-based) and electronic (computerized) clinical physiotherapy records. The content of the records and the software’s user acceptability were considered. Methods: A neuro-musculoskeletal patient scenario involving two encounters (initial and follow-up) was scripted and role-played to each of three experienced physiotherapists (A, B and C). Participants assessed the patient and made traditional clinical records. After basic training in an electronic record system, they repeated the assessments and made electronic records via a laptop computer. Three experienced physiotherapists (A, D and E) each used their usual method to write a clinical report and an electronic record to write a report with the aid of the software’s report tool. The two participants who wrote reports but did not assess the patient (D and E) received a brief software demonstration just prior to writing the electronic record report. The electronic and traditional cli...
Validity of electronic health record-derived quality measurement for performance monitoring
Journal of the American Medical Informatics Association, 2012
Background Since 2007, New York City's primary care information project has assisted over 3000 providers to adopt and use a prevention-oriented electronic health record (EHR). Participating practices were taught to readjust their workflows to use the EHR built-in population health monitoring tools, including automated quality measures, patient registries and a clinical decision support system. Practices received a comprehensive suite of technical assistance, which included quality improvement, EHR customization and configuration, privacy and security training, and revenue cycle optimization. These services were aimed at helping providers understand how to use their EHR to track and improve the quality of care delivered to patients. Materials and Methods Retrospective electronic chart reviews of 4081 patient records across 57 practices were analyzed to determine the validity of EHR-derived quality measures and documented preventive services.
2017
With advances in information and communication technologies (ICT), changes have been produced in physiotherapy provision. However, low adoption of the new technologies calls attention for better theoretical model and methods for ICT design, which may fulfil the needs of health professionals and their patients. In this work we discuss the framework for designing ICT for physiotherapy context based on some of the results obtained during research on requirements and barriers of electronic health records adoption in physiotherapy. We underscore the importance of considering the context the conditions in social and physical environment as well as end-users internal conditions for requirements elicitation of the healthcare information system. Identification, training and collaboration with champion/leader in the target community may contribute to creation and evolution of knowledge and innovation ecosystem for dynamic progress in designing and developing of ICT tailored to the people’ nee...
Background: Assessing quality of care from the patient’s perspective has changed from patient satisfaction to the more general term patient experience, as satisfaction measures turned out to be less discriminative due to high scores. Literature describes four to ten dimensions of patient experience, tailored to specific conditions or types of care. Given the administrative burden on patients, less dimensions and items could increase feasibility. Ten dimensions of patient experiences with physical therapy (PT) were proposed in the Netherlands in a consensus-based process with patients, physical therapists, health insurers, and policy makers. The aim of this paper is to detect the number of dimensions from data of a field study using factor analysis at item level. Methods: A web-based survey yielded data of 2,221 patients from 52 PT practices on 41 items. Principal component factor analysis at item level was used to assess the proposed distinction between the ten dimensions. Results: Factor analysis revealed two dimensions: ‘personal interaction’ and ‘practice organisation’. The dimension ‘patient reported outcome’ was artificially established. The three dimensions ‘personal interaction’ (14 items) (medianpractice level = 91.1; IQR = 2.4), ‘practice organisation’ (9 items) (medianpractice level = 88.9; IQR = 6.0) and ‘outcome’ (3 items) (medianpractice level = 80.6; IQR = 19.5) reduced the number of dimensions from ten to three and the number of items by more than a third. Conclusions: Factor analysis revealed three dimensions and achieved an item reduction of more than a third. It is a relevant step in the development process of a quality measurement tool to reduce respondent burden, increase clarity, and promote feasibility.
Physical therapy, 2017
Background. In 2013, the Royal Dutch Society for Physical Therapy launched the program "Quality in Motion." This program aims to collect data from electronic health record systems in a registry that is fed back to physical therapists, facilitating quality improvement. Purpose. The purpose of this study was to describe the development of an implementation strategy for the program and to evaluate the feasibility of building a registry and implementing patient-reported outcome measures (PROMs) in physical therapist practices. Methods. A stepwise approach using mixed methods was established in 3 consecutive pilots with 355 physical therapists from 66 practices. Interim results were evaluated using quantitative data from a self-assessment questionnaire and the registry and qualitative data from 21 semistructured interviews with physical therapists. Descriptive statistics and McNemar's symmetry chi-squared test were used to summarize the feasibility of implementing PROMs. Results. PROMs were selected for the 5 most prevalent musculoskeletal conditions in Dutch physical therapist practices. A core component of the implementation strategy was the introduction of knowledge brokers to support physical therapists in establishing the routine use of PROMs in clinical practice and to assist in executing peer assessment workshops. In February 2013, 30.3% of the physical therapist practices delivered 4.4 completed treatment episodes per physical therapist to the registry; this increased to 92.4% in November 2014, delivering 54.1 completed patient episodes per physical therapist. Pre-and posttreatment PROM use increased from 12.2% to 39.5%. Limitations. It is unclear if the participating physical therapists reflect a representative sample of Dutch therapists. Conclusion. Building a registry and implementing PROMs in physical therapist practices are feasible. The routine use of PROMs needs to increase to ensure valid feedback of outcomes. Using knowledge brokers is promising for implementing the program via peer assessment workshops.
Addressing electronic clinical information in the construction of quality measures
Academic pediatrics
Electronic health records (EHR) and registries play a central role in health care and provide access to detailed clinical information at the individual, institutional, and population level. Use of these data for clinical quality/performance improvement and cost management has been a focus of policy initiatives over the past decade. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)-mandated Pediatric Quality Measurement Program supports development and testing of quality measures for children on the basis of electronic clinical information, including de novo measures and respecification of existing measures designed for other data sources. Drawing on the experience of Centers of Excellence, we review both structural and pragmatic considerations in e-measurement. The presence of primary observations in EHR-derived data make it possible to measure outcomes in ways that are difficult with administrative data alone. However, relevant information may be loca...
Physiotherapy Canada, 2019
Purpose: Patient-reported outcome measures (PROMs) have the potential to enhance the quality of health care but, as a result of suboptimal implementa tion, it is unclear whether they fulfil this role in physiotherapy practice. This cross-sectional study aimed to identify the factors influencing PROM use in Dutch private physiotherapy practices. Method: A total of 444 physiotherapists completed a self-assessment questionnaire and uploaded the data from their electronic health record (EHR) systems to the national registry of outcome data. Univariate and multivariate ordinal logistic and linear regression analy sis were used to identify the factors associated with self-reported PROM use and PROM use registered in the EHR systems, which were derived from the self-assessment questionnaire and from the data in the national registry, respectively. Five categories with nine independent variables were selected as potential factors for regression analysis. The similarity between self-reported and registered PROM use was verified. Results: On the basis of self-report and EHR report, we found that 21.6% and 29.8% of participants, respectively, used PROMs with more than 80% of their patients, and we identified the fac tors associated with PROM use. Conclusions: The factors associated with PROM use are EHR systems that support PROM use and more knowledge about PROM use. These findings can guide future strategies to enhance the use of PROMs in physiotherapy practice.
Measuring and Comparing Data Quality in Electronic Health Care Records
The quality of information depends on the quality of data from which it is derived, but data are of high quality only if they are fit for their intended use. Although electronic health records are collected mainly for patient care and audits, their use in research can also greatly benefit the quality of life of patients. The aim of this workshop is to discuss the challenges and issues involved with measuring data quality in electronic health records for epidemiological and clinical research. Although there has been a vast amount of literature on data quality in general, there exists no common framework or methodology for defining and comparing data quality in medical databases used for research. In this workshop we shall share our experiences of assessing data quality in primary care databases and discuss and develop a suggested framework that can help ensure compatibility of data quality measures for different European primary care databases. We shall also discuss how best to use this framework and the results of our investigations to help data contributors improve the quality of data at source.