Using IT to Improve the Quality of Cardiovascular Disease (CVD) Prevention and Management

This study developed electronic medical record (EMR)-based quality indices for eleven cardiovascular primary care services. It related physicians' prior index scores to subsequent disease incidence and to care utilization in their patients. Data for the study were collected over an 11-year period by two Kaiser Permanente organizations covering approximately 750,000 persons in Hawaii and the Pacific Northwest of the United States, representing geographically and ethnically diverse populations.

Two index types were developed for defined annual intervals based on observations of defined populations: Prevention Indices (PI) and Disease Management Indices (DMIs). The PI is a measure of the extent to which a screening or preventive service was delivered to a defined population during a defined interval. The DMI is a measure of how effectively a disease or condition was managed in the population defined by the pertinent diagnosis during a defined interval.

The objectives of this project were to:

1. Identify practice-level primary care variations in preventive care, weight management, chronic disease management, and drug prescription patterns in the treatment of cardiovascular disease (CVD).
2. Determine the associations that quality of preventive care and disease management practices have to CVD morbidity, mortality, and costs of care.
3. Improve delivery of care.

Longitudinal and cross-sectional variation in practice patterns differed by service type and by organization. Higher DMI scores for blood pressure were associated with lower incident disease and care utilization. The PI for lipid screening was associated with reduced annual outpatient care utilization. The study team concluded that there are many causes of failure to provide recommended care. Some are difficult for health systems to address such as inadequate resources, poor quality clinical guidelines, and inaccurate or nonspecific diagnostic tests. Causes more easily addressed include organizational deficiencies, clinician failure to recommend appropriate services, and patient refusal to follow recommendations. In settings where EMR data are accessible to providers and patients, the PI and DMI evaluate care based on the same information available to the parties who are accountable for care. Quality indices based on PI and DMI information have a basic functional validity. Several of the indices implemented in the project show sufficient promise to warrant additional development.