title: [Assessment of electronic medical records. Relationship between process indicators measured using electronic records and intermediate health outcomes in patients with hypertension].
abstract: OBJECTIVE
  To study relationship between institutional process indicators (measured using electronic records) and intermediate outcomes of patients with hypertension.
  
  
  METHODS
  Cross-sectional epidemiological study.
  
  
  METHODS
  Primary Care Health District 1. Madrid. 2010.
  
  
  METHODS
  All patients with hypertension. n=80,306.
  
  
  METHODS
  Variables. Independent. Institutional process indicators. Dependent. Intermediate outcomes: blood pressure within target limits, LDL-cholesterol, tobacco and weight and detected complications. Confounding. Age, gender, co-morbidity, drugs and professional variables.
  
  
  RESULTS
  The BP of 55.1% (SE 0.2%) of patients was within target limits. Bivariate analysis and multivariate logistic regression showed that the recording of some process indicators was associated with an increase in the probability to achieve targets in intermediate outcomes: smoking advice (OR: 1.69, 95% CI: 1.61 - 1.77), reviewing personal history (OR: 1.54, 95% CI:1.42-1.68), increase was less or biased: BP (OR: 1.19, 95% CI:1.14-1.25), sodium and potassium (OR: 1.14, 95% CI:1.09-1.19), BMI (OR 1.08, 95% CI:1.04-1.12); also diabetes, edema, and creatinine, but there was timing bias. The relationship between other indicators (those oriented to lifestyle, family history, classification, urine examination, reviewing of drug therapy, LDL, electrocardiogram and cardiac auscultation) and a higher probability to achieve targets was not found.
  
  
  CONCLUSIONS
  In hypertension, some institutional process indicators measured on electronic records were associated with an increase in the probability to achieve targets in intermediate outcomes. No relationship was found between other indicators. This suggests maintaining process and outcome measurement, to include the impact of interventions, to prioritize improvements in process indicators that show low performance and high impact and to remove or to change process indicators where no relationship is found.
authors.affiliation: Gerencia AP, Servicio Madrileño de Salud, Madrid, España. ggarzon.gapm01@salud.madrid.org
authors.forename: Gerardo
authors.initials: G
authors.lastname: Garzón González
authors.forename: David
authors.initials: D
authors.lastname: Rodríguez Morales
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Rodríguez Palomino
authors.forename: David
authors.initials: D
authors.lastname: Toledo Gómez
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernández Barrera
authors.forename: Angel
authors.initials: A
authors.lastname: Gil De Miguel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D006268:Health Facilities; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D055815:Young Adult