title: Quality of congestive heart failure care: assessing measurement of care using electronic medical records.
abstract: OBJECTIVE
  To study the feasibility of using electronic medical record (EMR) data from the Deliver Primary Healthcare Information (DELPHI) database to measure quality of care for patients with congestive heart failure (CHF) in primary care and to determine the percentage of patients with CHF receiving the recommended care.
  
  
  METHODS
  Items listed on the Ontario Ministry of Health and Long-Term Care Heart Failure Patient Care Flow Sheet (CHF flow sheet) were assessed and measured using EMRs of patients diagnosed with CHF between October 1, 2005, and September 30, 2008.
  
  
  METHODS
  Ten primary health care practices in southwestern Ontario.
  
  
  METHODS
  Four hundred eighty-eight patients who were considered to have CHF because at least 1 of the following was indicated in their EMRs: an International Classification of Diseases billing code for CHF (category 428), an International Classification of Primary Care diagnosis code for heart failure (ie, K77), or "CHF" reported on the problem list.
  
  
  METHODS
  Number of CHF flow sheet items that were measurable using EMR data from the DELPHI database. Percentage of patients with CHF receiving required quality-of-care items since the date of diagnosis.
  
  
  RESULTS
  The DELPHI database contained information on 60 (65.9%) of the 91 items identified using the CHF flow sheet. The recommended tests and procedures were recorded infrequently: 55.5% of patients with CHF had chest radiographs; 32.6% had electrocardiograms; 32.2% had echocardiograms; 30.5% were prescribed angiotensin-converting enzyme inhibitors; 20.9% were prescribed β-blockers; and 15.8% were prescribed angiotensin II receptor blockers.
  
  
  CONCLUSIONS
  Low frequencies of recommended care items for patients with CHF were recorded in the EMR. Physicians explained that CHF care was documented in areas of the EMR that contained patient identifiers, such as the encounter notes, and was therefore not part of the DELPHI database. Extractable information from the EMR does not provide a complete picture of the quality of care provided to patients with CHF.
authors.affiliation: University of Western Ontario, Centre for Studies in Family Medicine, 245-100 Collip Circle, London, ON N6G 4X8. hlmaddoc@uwo.ca
authors.forename: Heather
authors.initials: H
authors.lastname: Maddocks
authors.forename: J Neil
authors.initials: JN
authors.lastname: Marshall
authors.forename: Moira
authors.initials: M
authors.lastname: Stewart
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Terry
authors.forename: Sonny
authors.initials: S
authors.lastname: Cejic
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Hammond
authors.forename: John
authors.initials: J
authors.lastname: Jordan
authors.forename: Vijaya
authors.initials: V
authors.lastname: Chevendra
authors.forename: Louisa Bestard
authors.initials: LB
authors.lastname: Denomme
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
mesh_terms: D016208:Databases, Factual / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D009864:Ontario; D011320:Primary Health Care; D011787:Quality of Health Care; D012107:Research Design