An educational intervention to improve data recording in the management of ischaemic heart disease in primary care.
BACKGROUND
Gaps in computerized medical records and a lack of a systematic approach to data recording make progress towards achieving quality standards in primary care difficult to demonstrate. The aim of this study was to examine the effect of an educational intervention on data quality in primary care.


METHODS
A before-and-after study of key data quality measures was carried out in 87 general practices in eight primary care organizations in England in phase 1 and 84 general practices in phase 2. The subjects were 19,470 patients with ischaemic heart disease in phase 1 and 19,784 patients in phase 2. The main outcome measures were improvement in the completeness and quality of the computerized medical record. Anonymized data were extracted from clinical information systems and processed to produce comparative information on each practice. Data quality workshops were arranged, in which reflection can take place, backed up by summary statistics. Practice visits provided training and personalized feedback of patients needing intervention.


RESULTS
In the patients with heart disease, nearly 16,000 new clinical entries were made in the key improvement areas. The percentage of patients advised to quit smoking increased by 49.3 per cent, from 23.6 per cent to 61.9 per cent. There were also significant improvements in many other aspects of management.


CONCLUSIONS
Focused interventions that provide targeted and relevant clinical information can be implemented in primary care. Such interventions can lead to a rise in data quality in primary care, but their effectiveness needs to be further tested in more rigorous research settings such as randomized controlled trials.
de Lusignan
Simon
S
Primary Care Informatics, Department of General Practice and Primary Care, St. George's Hospital Medical School, London SW17 0RE. slusigna@sghms.ac.uk
Hague
Nigel
N
Brown
Adrian
A
Majeed
Azeem
A
D000555:Ambulatory Care Information Systems / Q000592:standards*; D065187:Controlled Before-After Studies; D004739:England; D005194:Family Practice / Q000193:education / Q000458:organization & administration*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000592:standards*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D011786:Quality Control; D019984:Quality Indicators, Health Care; D000074606:Smoking Prevention