Can structured data fields accurately measure quality of care? The example of falls

This article and any supplementary material should be cited as follows: Ganz DA, Almeida S, Roth CP, Reuben DB, Wenger NS. Can structured data fields accurately measure quality of care? The example of falls. J Rehabil Res Dev. 2012; 49(9):1411–20. http://dx.doi.org/10.1682/JRRD.2011.09.0184

Slideshow ProjectDOI:10.1682/JRRD.2011.09.0184JSP

Can structured data fields accurately measure quality of care?

The example of falls

David A. Ganz, MD, PhD; Shone Almeida, BS; Carol P. Roth, RN, MPH; David B. Reuben, MD;

Neil S. Wenger, MD, MPH



• Aim– Determine whether quality of care can be accurately

estimated from structured (non-free-text) fields in structured visit note (SVN) when SVN is part of routine documentation.

• Relevance– By automating collection of data elements, electronic

health records may simplify process of measuring quality of medical care.



Method– Used data from quality

improvement initiative in primary care medical groups.• Determined whether quality of

care for falls/fear of falling in outpatients aged 75+ could be accurately measured from codable data in SVN.

– Criterion standard was traditional medical record review by trained abstractors.

Sample SVN.



Results• 215 patient records reviewed.– SVN in 54% of charts within 3 mo of patients

identified as having falls or fear of falling. • Automated algorithm based on codable data:– Reliability was at least good (kappa ≥ 0.61) vs. full

medical record review for 3 care processes (ortho-static vital signs, vision test/eye examination, and home safety evaluation) recommended for patients with 2 falls or 1 fall with injury in past year.

– Routinely underestimated quality of care.



Conclusion

• Structured data should be used cautiously for measurement of quality of care and will likely underestimate actual care delivery.

• Degree to which structured data accurately represent underlying care delivered varies according to type of care process.

• Quality measurement systems using automated data will continue to benefit from validation against full medical record review.

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Can structured data fields accurately measure quality of care? The example of falls