title: Assessment of COPD-related outcomes via a national electronic medical record database.
abstract: OBJECTIVE
  The technology and sophistication of healthcare utilization databases have expanded over the last decade to include results of lab tests, vital signs, and other clinical information. This review provides an assessment of the methodological and analytical challenges of conducting chronic obstructive pulmonary disease (COPD) outcomes research in a national electronic medical records (EMR) dataset and its potential application towards the assessment of national health policy issues, as well as a description of the challenges or limitations.
  
  
  METHODS
  An EMR database and its application to measuring outcomes for COPD are described. The ability to measure adherence to the COPD evidence-based practice guidelines, generated by the NIH and HEDIS quality indicators, in this database was examined. Case studies, before and after their publication, were used to assess the adherence to guidelines and gauge the conformity to quality indicators.
  
  
  RESULTS
  EMR was the only source of information for pulmonary function tests, but low frequency in ordering by primary care was an issue. The EMR data can be used to explore impact of variation in healthcare provision on clinical outcomes. The EMR database permits access to specific lab data and biometric information.
  
  
  CONCLUSIONS
  The richness and depth of information on "real world" use of health services for large population-based analytical studies at relatively low cost render such databases an attractive resource for outcomes research. Various sources of information exist to perform outcomes research. It is important to understand the desired endpoints of such research and choose the appropriate database source.
authors.affiliation: Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT 84108, USA. carl.asche@pharm.utah.edu
authors.forename: Carl
authors.initials: C
authors.lastname: Asche
authors.forename: Quayyim
authors.initials: Q
authors.lastname: Said
authors.forename: Vijay
authors.initials: V
authors.lastname: Joish
authors.forename: Charles Oaxaca
authors.initials: CO
authors.lastname: Hall
authors.forename: Diana
authors.initials: D
authors.lastname: Brixner
mesh_terms: D006801:Humans; D016347:Medical Records Systems, Computerized; D019982:Organizational Case Studies / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States