Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions

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Abstract

Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before–after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures (P <.05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening (P <.05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.

Original languageEnglish (US)
JournalAmerican Journal of Medical Quality
DOIs
StateAccepted/In press - Oct 1 2017

Fingerprint

Clinical Decision Support Systems
Health
Early Detection of Cancer
Uterine Cervical Neoplasms
Osteoporosis
Pneumococcal Vaccines
Electronic Health Records
Information Systems
Colorectal Neoplasms
Vaccination
Breast
Breast Neoplasms

Keywords

  • clinical decision support
  • preventive care
  • primary care
  • quality measurement

ASJC Scopus subject areas

  • Health Policy

Cite this

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title = "Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions",
abstract = "Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before–after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures (P <.05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2{\%} to 10{\%}) and patient/medical exceptions (<3{\%}). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73{\%} vs 82{\%}); breast (69{\%} vs 75{\%}), colorectal (58{\%} vs 70{\%}), and cervical cancer (53{\%} vs 62{\%}); and osteoporosis (72{\%} vs 75{\%}) screening (P <.05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.",
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