Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico

Abstract

BackgroundSeveral low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM.MethodsWe used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009.ResultsWe developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose ≤130 mg/dl).ConclusionsEHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC.

Linking quality of healthcare and health-related quality of life of patients with type 2 diabetes: an evaluative study in Mexican family practice

“…We used the quality of care indicators developed and validated previously by our research group [16]. We ascertained the percentage of recommended care received in each quality of care domain by calculating a simple proportion [20].…”

Quality of Diabetes Care at Outpatient Clinic, Sultan Qaboos University Hospital

“…[22][23][24] Other studies reported it at 11-36%. 25,26 However, different criteria for blood pressure control among diabetics was used in different studies, which makes evaluation difficult.…”

Recent Research Areas and Grand Challenges in Electronic Medical Record: A Literature Survey Approach

“…For instance, Prez-Cuevas in his paper" Evaluation of alternative standardized terminologies for medical conditions within a network of observational healthcare databases" tried to identify care indicators for type 2 diabetes using patient data extracted from EMR [23] . Moreover, Wood and colleagues have stored obesityrelated variables in an EHR database and use them to find the best obesity measurement [24].…”