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

Michael E. Bowen*, Deepa Bhat, Jason Fish, Brett Moran, Temple Howell-Stampley, Lynne Kirk, Stephen D. Persell, Ethan A. Halm

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

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)
Pages (from-to)237-245
Number of pages9
JournalAmerican Journal of Medical Quality
Volume33
Issue number3
DOIs
StatePublished - May 1 2018

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a grant from the University of Texas Health System Chancellor’s Health Fellow for Information Technology initiative. Additional resources were provided by the UT Southwestern Center for Patient-Centered Outcomes Research (AHRQ R24 HS022418) and the Dedman Family Scholars in Clinical Care. Dr Bowen was supported by the National Center for Advancing Translational Sciences of the NIH (KL2TR001103) and the NIH/NIDDK K23 DK104065. Dr Halm was supported in part by AHRQ R24 HS022418.

Keywords

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

ASJC Scopus subject areas

  • Health Policy

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