title: Problems with primary care data quality: osteoporosis as an exemplar.
abstract: OBJECTIVE
  To report problems implementing a data quality programme in osteoporosis.
  
  
  METHODS
  Analysis of data extracted using Morbidity Information Query and Export Syntax (MIQUEST) from participating general practices' systems and recommendations of practitioners who attended an action research workshop.
  
  
  METHODS
  Computerised general practices using different Read code versions to record structured data.
  
  
  METHODS
  78 practices predominantly from London and the south east, with representation from north east, north west and south west England.
  
  
  METHODS
  Patients at risk can be represented in many ways within structured data. Although fracture data exists, it is unclear which are fragility fractures. T-scores, the gold standard for measuring bone density, cannot be extracted using the UK's standard data extraction tool, MIQUEST; instead manual searches had to be implemented. There is a hundredfold variation in data recording levels between practices. Therapy is more frequently recorded than diagnosis. A multidisciplinary forum of experienced practitioners proposed that a limited list of codes should be used.
  
  
  CONCLUSIONS
  There is variability in inter-practice data quality. Some clinically important codes are lacking, and there are multiple ways that the same clinical concept can be represented. Different practice computer systems have different versions of Read code, making some data incompatible. Manual searching is still required to find data. Clinicians with an understanding of what data are clinically relevant need to have a stronger voice in the production of codes, and in the creation of recommended lists.
authors.affiliation: Primary Care Informatics, Department of Community Health Sciences, St George's Hospital Medical School, London, UK. slusigna@sghms.ac.uk
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Tom
authors.initials: T
authors.lastname: Valentin
authors.forename: Tom
authors.initials: T
authors.lastname: Chan
authors.forename: Nigel
authors.initials: N
authors.lastname: Hague
authors.forename: Oliver
authors.initials: O
authors.lastname: Wood
authors.forename: Jeremy
authors.initials: J
authors.lastname: van Vlymen
authors.forename: Neil
authors.initials: N
authors.lastname: Dhoul
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D004739:England / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006801:Humans; D016347:Medical Records Systems, Computerized; D010024:Osteoporosis / Q000145:classification* / Q000209:etiology; D011786:Quality Control; D009626:Terminology as Topic