Routinely-collected general practice data are complex, but with systematic processing can be used for quality improvement and research

Primary Care Informatics, Division of Community Health Sciences, St George's Hospital Medical School, London, UK.
The Journal of Innovations in Health Informatics 02/2006; 14(1):59-66. DOI: 10.14236/jhi.v14i1.615
Source: PubMed


UK general practice is computerised, and quality targets based on computer data provide a further incentive to improve data quality. A National Programme for Information Technology is standardising the technical infrastructure and removing some of the barriers to data aggregation. Routinely collected data is an underused resource, yet little has been written about the wide range of factors that need to be taken into account if we are to infer meaning from general practice data.
To report the complexity of general practice computer data and factors that need to be taken into account in its processing and interpretation.
We run clinically focused programmes that provide clinically relevant feedback to clinicians, and overview statistics to localities and researchers. However, to take account of the complexity of these data we have carefully devised a system of process stages and process controls to maintain referential integrity, and improve data quality and error reduction. These are integrated into our design and processing stages. Our systems document the query, reference code set and create unique patient ID. The design stage is followed by appraisal of: data entry issues, how concepts might be represented in clinical systems, coding ambiguities, using surrogates where needed, validation and pilot-ing. The subsequent processing of data includes extraction, migration and integration of data from different sources, cleaning, processing and analysis.
Results are presented to illustrate issues with the population denominator, data entry problems, identification of people with unmet needs, and how routine data can be used for real-world testing of pharmaceuticals.
Routinely collected primary care data could contribute more to the process of health improvement; however, those working with these data need to understand fully the complexity of the context within which data entry takes place.

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Available from: Simon de Lusignan, Nov 23, 2015
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    • "However, data retrieval from the EMR is still complex [10] and in some cases registration of data is inadequate [14]. Because clinical consultation is a complex interaction between caregiver and patient, in EMRs the information is often recorded as a mixture of free-text and coded data [15]. Registration, here understood to be all or part of patient information, is influenced by personal, cultural, technical, health system and financial factors [9]. "
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    ABSTRACT: Patient information, medical history, clinical outcomes and demographic information, can be registered in different ways in registration programs. For evaluation of diabetes care, data can easily be extracted from a structured registration program (SRP). The usability of data from this source depends on the agreement of this data with that of the usual data registration in the electronic medical record (EMR).Aim of the study was to determine the comparability of data from an EMR and from an SRP, to determine whether the use of SRP data for quality assessment is justified in general practice. We obtained 196 records of diabetes mellitus patients in a sample of general practices in the Netherlands. We compared the agreement between the two programs in terms of laboratory and non-laboratory parameters. Agreement was determined by defining accordance between the programs in absent and present registrations, accordance between values of registrations, and whether the differences found in values were also a clinically relevant difference. No differences were found in the occurrence of registration (absent/present) in the SRP and EMR for all the laboratory parameters. Smoking behaviour, weight and eye examination were registered significantly more often in the SRP than in the EMR. In the EMR, blood pressure was registered significantly more often than in the SRP. Data registered in the EMR and in the SRP had a similar clinical meaning for all parameters (laboratory and non-laboratory). Laboratory parameters showed good agreement and non-laboratory acceptable agreement of the SRP with the EMR. Data from a structured registration program can be used validly for research purposes and quality assessment in general practice.
    Full-text · Article · Dec 2009 · BMC Health Services Research
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    • "Routinely collected general practice computer data are complex and require significant processing and interpretation in order to obtain meaningful information [36]. The research team has considerable experience and has developed a published method [37]. "
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    ABSTRACT: Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Cluster randomised controlled trial (CRT) This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention. Clinical Trials Registration ISRCTN56023731. identifier.
    Full-text · Article · Feb 2009 · Implementation Science
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    • "Computers are less good at coding vague complaints, social diagnoses, or physical manifestations of underlying psychological problems, which are often features of clinical consultations in primary care; although not all coding systems are the same. The United Kingdom has opted for comprehensive classification systems capable of coding most clinical concepts, whereas other countries successfully use more limited classifications (de Lusignan, 2006). Some factually corrected information (eg, depression; termination of pregnancy) can also be stigmatizing to patients and recording it can impair the doctor-patient relationship (de Lusignan et al., 2003). "
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    ABSTRACT: UK primary care is highly computerized; initially led by enthusiastic general practitioners who developed their own systems. This preceded the development of a National Health Service information strategy and an ambitious National Programme for IT. A 4-element model is proposed to explain the development of information technology: (1) individual clinician choice; (2) integration into the clinical task--usually an office visit; (3) technological developments; and (4) organizational factors. All 4 elements of this model have been tilted in favor of the utilization of information technology; lessons from the United Kingdom may help other health systems looking to implement information technology systems in primary care.
    Full-text · Article · Jul 2008 · The Journal of ambulatory care management
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