title: Using Electronic Health Record Data to Measure Care Quality for Individuals with Multiple Chronic Medical Conditions.
abstract: To inform the development of a data-driven measure of quality care for individuals with multiple chronic conditions (MCCs) derived from an electronic health record (EHR).
  
  
  
  Qualitative study using focus groups, interactive webinars, and a modified Delphi process.
  
  
  
  Research department within an integrated delivery system.
  
  
  
  The webinars and Delphi process included 17 experts in clinical geriatrics and primary care, health policy, quality assessment, health technology, and health system operations. The focus group included 10 individuals aged 70-87 with three to six chronic conditions selected from a random sample of individuals aged 65 and older with three or more chronic medical conditions.
  
  
  
  Through webinars and the focus group, input was solicited on constructs representing high-quality care for individuals with MCCs. A working list was created of potential measures representing these constructs. Using a modified Delphi process, experts rated the importance of each possible measure and the feasibility of implementing each measure using EHR data.
  
  
  
  High-priority constructs reflected processes rather than outcomes of care. High-priority constructs that were potentially feasible to measure included assessing physical function, depression screening, medication reconciliation, annual influenza vaccination, outreach after hospital admission, and documented advance directives. High-priority constructs that were less feasible to measure included goal setting and shared decision-making, identifying drug-drug interactions, assessing social support, timely communication with patients, and other aspects of good customer service. Lower-priority domains included pain assessment, continuity of care, and overuse of screening or laboratory testing.
  
  
  
  High-quality MCC care should be measured using meaningful process measures rather than outcomes. Although some care processes are currently extractable from electronic data, capturing others will require adapting and applying technology to encourage holistic, person-centered care.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado. elizabeth.bayliss@kp.org.|Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado. elizabeth.bayliss@kp.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Deanna B
authors.initials: DB
authors.lastname: McQuillan
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ellis
authors.affiliation: Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Chan
authors.initials: C
authors.lastname: Zeng
authors.affiliation: National Committee for Quality Assurance, Washington, District of Columbia.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Barton
authors.affiliation: Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.affiliation: Department of Family Medicine, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Quebec, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Fortin
authors.affiliation: Centers for Medicare and Medicaid Services, Baltimore, Maryland.
authors.forename: Shari M
authors.initials: SM
authors.lastname: Ling
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, California.
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, Washington.
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.|Division of General Medical Disciplines, Stanford University, Stanford, California.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Zulman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D015897:Comorbidity; D003697:Delphi Technique; D057286:Electronic Health Records; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D036301:Qualitative Research; D058996:Quality Improvement; D011787:Quality of Health Care
keywords: electronic health record; multimorbidity; quality