title: Changes in performance after implementation of a multifaceted electronic-health-record-based quality improvement system.
abstract: BACKGROUND
  Electronic health record (EHR) systems have the potential to revolutionize quality improvement (QI) methods by enhancing quality measurement and integrating multiple proven QI strategies.
  
  
  OBJECTIVE
  To implement and evaluate a multifaceted QI intervention using EHR tools to improve quality measurement (including capture of contraindications and patient refusals), make point-of-care reminders more accurate, and provide more valid and responsive clinician feedback (including lists of patients not receiving essential medications) for 16 chronic disease and preventive service measures.
  
  
  METHODS
  Time series analysis at a large internal medicine practice using a commercial EHR.
  
  
  METHODS
  All adult patients eligible for each measure (range approximately 100-7500).
  
  
  METHODS
  The proportion of eligible patients who satisfied each measure after removing those with exceptions from the denominator.
  
  
  RESULTS
  During the year before the intervention, performance improved significantly for 8 measures. During the year after the intervention, performance improved significantly for 14 measures. For 9 measures, the primary outcome improved more rapidly during the intervention year than during the previous year (P < 0.001 for 8 measures, P = 0.02 for 1). Four other measures improved at rates that were not significantly different from the previous year. Improvements resulted from increases in patients receiving the service, documentation of exceptions, or a combination of both. For 5 drug-prescribing measures, more than half of physicians achieved 100% performance.
  
  
  CONCLUSIONS
  Implementation of a multifaceted QI intervention using EHR tools to improve quality measurement and the accuracy and timeliness of clinician feedback improved performance and/or accelerated the rate of improvement for multiple measures simultaneously.
authors.affiliation: Division of General Internal Medicine, Feinberg School of Medicine, Institute for Healthcare Studies, Northwestern University, Chicago, IL 60611, USA. spersell@nmff.org
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Persell
authors.forename: Darren
authors.initials: D
authors.lastname: Kaiser
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Dolan
authors.forename: Beth
authors.initials: B
authors.lastname: Andrews
authors.forename: Sue
authors.initials: S
authors.lastname: Levi
authors.forename: Janardan
authors.initials: J
authors.lastname: Khandekar
authors.forename: Thomas
authors.initials: T
authors.lastname: Gavagan
authors.forename: Jason A
authors.initials: JA
authors.lastname: Thompson
authors.forename: Elisha M
authors.initials: EM
authors.lastname: Friesema
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
mesh_terms: D000368:Aged; D002641:Chicago; D003327:Coronary Disease / Q000188:drug therapy; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000188:drug therapy; D004282:Documentation; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D017010:Reminder Systems; D017749:Total Quality Management / Q000458:organization & administration*