title: Making audit actionable: an example algorithm for blood pressure management in chronic kidney disease.
abstract: Despite widespread use of clinical guidelines, actual care often falls short of ideal standards. Electronic health records (EHR) can be analyzed to provide information on how to improve care, but this is seldom done in sufficient detail to guide specific action. We developed an algorithm to provide practical, actionable information for care quality improvement using blood pressure (BP) management in chronic kidney disease (CKD) as an exemplar. We used UK clinical guidelines and EHR data from 440 patients in Salford (UK) to develop the algorithm. We then applied it to 532,409 individual patient records, identifying 11,097 CKD patients, 3,766 (34%) of which showed room for improvement in their care: either through medication optimization or better BP monitoring. Manual record reviews to evaluate accuracy indicated a positive-predictive value of 90%. Such algorithms could help improve the management of chronic conditions by providing the missing link between clinical audit and decision support.
authors.affiliation: Centre for Health Informatics, University of Manchester, UK ; Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Brown
authors.affiliation: Centre for Health Informatics, University of Manchester, UK ; Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.affiliation: Centre for Health Informatics, University of Manchester, UK ; Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sperrin
authors.affiliation: Centre for Health Informatics, University of Manchester, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Frank
authors.affiliation: Centre for Health Informatics, University of Manchester, UK ; Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, UK.
authors.forename: John
authors.initials: J
authors.lastname: Ainsworth
authors.affiliation: Centre for Health Informatics, University of Manchester, UK ; Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
mesh_terms: D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D019468:Disease Management; D057286:Electronic Health Records; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010349:Patient Compliance; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D000959:Antihypertensive Agents