TY - JOUR
T1 - Medical records and quality of care in acute coronary syndromes
T2 - Results from CRUSADE
AU - Dunlay, Shannon M.
AU - Alexander, Karen P.
AU - Melloni, Chiara
AU - Kraschnewski, Jennifer L.
AU - Liang, Li
AU - Gibler, W. Brian
AU - Roe, Matthew T.
AU - Ohman, E. Magnus
AU - Peterson, Eric D.
PY - 2008/8/25
Y1 - 2008/8/25
N2 - Background: Patient medical records are important means of communication among health care providers. Limited evaluation has been performed of the quality of the medical records or its association with health care processes or outcomes. Methods: We performed an empirical evaluation of the completeness of medical records from 607 randomly selected patients admitted with non-ST-segment elevation acute coronary syndromes (NSTE ACS) to 219 US hospitals in the CRUSADE National Quality Improvement Initiative. Composite medical records scores were summated and compared by hospital academic status and physician specialty. Correlations between medical records scores, use of evidence-based medicine (EBM), and in-hospital mortality were assessed. Results: Medical records were frequently missing key elements, including cardiac history (23.6%), performance status (64.6%), differential diagnosis (57.8%), and planned use of EBM (44.0%). Evidence-based medicine was more often discussed in medical records from academic medical centers vs nonacademic medical centers (69.7% vs 51.7%) (P<.001) and from cardiologists vs noncardiologists (60.5% vs 48.1%, P=.003). Higher medical records quality scores were associated with greater use of EBM among the medical records quality cohort (P=.006), and a similar trend was observed in CRUSADE overall: adjusted odds ratio, 1.26 (95% confidence interval, 0.92-1.72) for high vs low medical records quality. Higher medical records quality scores were associated with lower in-hospital mortality: adjusted odds ratio, 0.79 (95% confidence interval, 0.65-0.97). Conclusions: Medical records for patients with NSTE ACS often lack key elements of the history and physical examination. Patients treated at hospitals with better medical records quality have significantly lower mortality and may receive more EBM. The relationship between better medical charting and better medical care could lead to new ways to monitor and improve the quality of medical care.
AB - Background: Patient medical records are important means of communication among health care providers. Limited evaluation has been performed of the quality of the medical records or its association with health care processes or outcomes. Methods: We performed an empirical evaluation of the completeness of medical records from 607 randomly selected patients admitted with non-ST-segment elevation acute coronary syndromes (NSTE ACS) to 219 US hospitals in the CRUSADE National Quality Improvement Initiative. Composite medical records scores were summated and compared by hospital academic status and physician specialty. Correlations between medical records scores, use of evidence-based medicine (EBM), and in-hospital mortality were assessed. Results: Medical records were frequently missing key elements, including cardiac history (23.6%), performance status (64.6%), differential diagnosis (57.8%), and planned use of EBM (44.0%). Evidence-based medicine was more often discussed in medical records from academic medical centers vs nonacademic medical centers (69.7% vs 51.7%) (P<.001) and from cardiologists vs noncardiologists (60.5% vs 48.1%, P=.003). Higher medical records quality scores were associated with greater use of EBM among the medical records quality cohort (P=.006), and a similar trend was observed in CRUSADE overall: adjusted odds ratio, 1.26 (95% confidence interval, 0.92-1.72) for high vs low medical records quality. Higher medical records quality scores were associated with lower in-hospital mortality: adjusted odds ratio, 0.79 (95% confidence interval, 0.65-0.97). Conclusions: Medical records for patients with NSTE ACS often lack key elements of the history and physical examination. Patients treated at hospitals with better medical records quality have significantly lower mortality and may receive more EBM. The relationship between better medical charting and better medical care could lead to new ways to monitor and improve the quality of medical care.
UR - http://www.scopus.com/inward/record.url?scp=49449116332&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=49449116332&partnerID=8YFLogxK
U2 - 10.1001/archinte.168.15.1692
DO - 10.1001/archinte.168.15.1692
M3 - Article
C2 - 18695085
AN - SCOPUS:49449116332
SN - 0003-9926
VL - 168
SP - 1692
EP - 1698
JO - Archives of Internal Medicine
JF - Archives of Internal Medicine
IS - 15
ER -