Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Systematic Review

Abstract

Background Long-term care for patients with chronic diseases poses a huge challenge in primary care. In particular, there is a deficit regarding monitoring and structured follow-up. Appropriate electronic medical records (EMRs) could help improving this but, so far, there are no evidence-based specifications concerning the indicators that should be monitored at regular intervals. Objective The aim was to identify and collect a set of evidence-based indicators that could be used for monitoring chronic conditions at regular intervals in primary care using EMRs. Methods We searched MEDLINE (Ovid), Embase (Elsevier), the Cochrane Library (Wiley), the reference lists of included studies and relevant reviews, and the content of clinical guidelines. We included primary studies and guidelines reporting about indicators that allow for the assessment of care and help monitor the status and process of disease for five chronic conditions, including type 2 diabetes mellitus, asthma, arterial hypertension, chronic heart failure, and osteoarthritis. Results The use of the term “monitoring” in terms of disease management and long-term care for patients with chronic diseases is not widely used in the literature. Nevertheless, we identified a substantial number of disease-specific indicators that can be used for routine monitoring of chronic diseases in primary care by means of EMRs. Conclusions To our knowledge, this is the first systematic review summarizing the existing scientific evidence on the standardized long-term monitoring of chronic diseases using EMRs. In a second step, our extensive set of indicators will serve as a generic template for evaluating their usability by means of an adapted Delphi procedure. In a third step, the indicators will be summarized into a user-friendly EMR layout.

Evaluation of type 2 diabetes care management in nine primary care practices before and after implementation of the Criteria of Good Disease Management of Diabetes established by the Swiss Society of Endocrinology and Diabetology

“…In contrast, financial incentives did not seem to influence quality of care [15]. However, we have to acknowledge that the study design of interventions to optimise quality of care are heterogeneous and implemented in different clinical settings, and various outcomes have been used as proxy of quality of care, such as HbA1c levels and cardiovascular risk factors [14,16,17], leading to lack of generalisability of the results [13]. Moreover, the definition of quality of care in diabetes management is not well defined and varies widely between different countries, as it is highly dependent on the local healthcare systems.…”

Standardization of Reporting Obstructive Airway Disease in Children: A National Delphi Process

“…The 17 features used in the diagnosis section, in addition to the diagnosis itself, were: (1) certainty of diagnosis (e.g., "suspected" and "probably"); (2) age related phenotype (e.g., "pediatric," "infant," and "toddler"); (3) symptoms (such as "cough" and "dyspnea"); (4) symptom perception; (5) pattern of symptoms over time (e.g., "recurrent," "chronic," and "episodic"); (6) seasonal or perennial; (7) triggers (e.g., "allergic," "infection," J o u r n a l P r e -p r o o f and "exercise"); (8) related measures of disease severity, including terms describing the severity directly, such as "mild," "severe," and "difficult to treat," along with terms describing the frequency and severity of exacerbations, stability, and the effects on daily life; (9) lung function, which included the terms "obstructive," "partially reversible," and forced expiratory volume in 1 second (FEV1) values; (10) airway inflammation (e.g., fractional exhaled nitric oxide (FeNO) values); (11) airway hyperresponsiveness (e.g., "mild," "moderate," or "severe hyperresponsiveness" in "methacholine," "mannitol," or "exercise challenge test"); ( 12) atopy, including terms describing allergens children are sensitized to and the clinical relevance of the sensitizations; ( 13) therapy (e.g., medications); (14) symptom control (e.g., "uncontrolled" and "well controlled"); (15) therapy response (e.g., "poor" or "good response to treatment"); ( 16) compliance (e.g., "malcompliance" and "medication frequently forgotten"); ( 17) risk of future asthma (e.g., asthma predictive index…”

“…This does not reflect the current scientific understanding. Previous studies aiming to standardize reporting for obstructive airway disease assessed which features were reported by guidelines and studies, but not the terms used in clinical practice [10][11][12][13]. The few exceptions were done in an adult primary care setting [14,15].…”

Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Development of a Tool by Adapted Delphi Procedure

“…In the first phase of this study [9], we performed a systematic review to identify and assess a set of clinical indicators that can be used for monitoring chronic diseases in primary care. In this study, we selected clinical indicators for five diseases that have high prevalence globally and are associated with multimorbidity and polypharmacy including type 2 diabetes mellitus, arterial hypertension, chronic heart failure, asthma, and osteoarthritis [10,11].…”

“…We have previously identified a structured set of evidence-based indicators for five common chronic conditions [9]. In this study we aimed to develop an evidence-based standardized, generic template that improves monitoring of patients with chronic conditions in primary care by means of an EMR.…”