title: The TAR model: use of therapeutic state transitions for quality assurance reporting in chronic disease management.
abstract: Chronic disease management represents one of the challenges for health informatics and demands the appropriate application of information technology for improved patient care. This paper presents an approach to quality assurance reporting wherein the recommendations of evidence-based clinical practice guidelines are considered in the context of empirical therapeutic state-transitions (in terms of changes in individual patient prescriptions over time). We apply a Transition-based Audit Report (TAR) model to antihypertensive prescribing and related data as stored in a New Zealand General Practice Management System database. The results provide a set of quality indicators and specific patient cohorts for potential practice quality improvement with strong linkage to the selected guidelines and observed practice patterns. We see the TAR model primarily as a tool to enable internal quality improvement efforts, but also to be of relevance for focusing pay-for-performance programs.
authors.affiliation: Department of Computer Science, The University of Auckland, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Gaikwad
authors.forename: J
authors.initials: J
authors.lastname: Warren
authors.forename: T
authors.initials: T
authors.lastname: Kenealy
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D019468:Disease Management; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care