PDF(Pubmed)
Abstract：
BACKGROUND: Digital applications that automatically extract information from electronic medical records and provide comparative visualizations of the data in the form of quality indicators to primary care practices may facilitate local quality improvement (QI). A necessary condition for such QI to work is that practices actively access the data. The purpose of this study was to explore the use of an application that visualizes quality indicators in Swedish primary care, developed by a profession-led QI initiative (\"Primärvårdskvalitet\"). We also describe the characteristics of practices that used the application more or less extensively, and the relationships between the intensity of use and changes in selected performance indicators.
METHODS: We studied longitudinal data on 122 primary care practices\' visits to pages (page views) in the application over a period up to 5 years. We compared high and low users, classified by the average number of monthly page views, with respect to practice and patient characteristics as well as baseline measurements of a subset of the performance indicators. We estimated linear associations between visits to pages with diabetes-related indicators and the change in measurements of selected diabetes indicators over 1.5 years.
RESULTS: Less than half of all practices accessed the data in a given month, although most practices accessed the data during at least one third of the observed months. High and low users were similar in terms of most studied characteristics. We found statistically significant positive associations between use of the diabetes indicators and changes in measurements of three diabetes indicators.
CONCLUSIONS: Although most practices in this study indicated an interest in the automated feedback reports, the intensity of use can be described as varying and on average limited. The positive associations between the use and changes in performance suggest that policymakers should increase their support of practices\' QI efforts. Such support may include providing a formalized structure for peer group discussions of data, facilitating both understanding of the data and possible action points to improve performance, while maintaining a profession-led use of applications.
METHODS: We studied longitudinal data on 122 primary care practices\' visits to pages (page views) in the application over a period up to 5 years. We compared high and low users, classified by the average number of monthly page views, with respect to practice and patient characteristics as well as baseline measurements of a subset of the performance indicators. We estimated linear associations between visits to pages with diabetes-related indicators and the change in measurements of selected diabetes indicators over 1.5 years.
RESULTS: Less than half of all practices accessed the data in a given month, although most practices accessed the data during at least one third of the observed months. High and low users were similar in terms of most studied characteristics. We found statistically significant positive associations between use of the diabetes indicators and changes in measurements of three diabetes indicators.
CONCLUSIONS: Although most practices in this study indicated an interest in the automated feedback reports, the intensity of use can be described as varying and on average limited. The positive associations between the use and changes in performance suggest that policymakers should increase their support of practices\' QI efforts. Such support may include providing a formalized structure for peer group discussions of data, facilitating both understanding of the data and possible action points to improve performance, while maintaining a profession-led use of applications.
摘要：
背景：自动从电子病历中提取信息并以质量指标的形式向初级保健实践提供数据的比较可视化的数字应用程序可以促进本地质量改进（QI）。这种QI工作的必要条件是实践主动访问数据。这项研究的目的是探索在瑞典初级保健中可视化质量指标的应用程序的使用，由专业主导的QI计划（“Primärvárdskvalitet”）开发。我们还描述了或多或少广泛使用该应用程序的实践的特征，以及使用强度与选定绩效指标变化之间的关系。
方法：我们在长达5年的时间内研究了122项初级保健实践\'访问页面（页面视图）的纵向数据。我们比较了高用户和低用户，按每月平均页面浏览量分类，关于实践和患者特征以及性能指标子集的基线测量。我们估计了在1.5年内，对具有糖尿病相关指标的页面的访问与所选糖尿病指标的测量变化之间的线性关联。
结果：在给定月份中，不到一半的所有实践访问了数据，尽管大多数实践在至少三分之一的观察月份访问了数据。就研究最多的特征而言，高用户和低用户相似。我们发现糖尿病指标的使用与三个糖尿病指标的测量变化之间存在统计学上的显着正相关。
结论：尽管本研究中的大多数实践表明对自动反馈报告感兴趣，使用强度可以描述为变化和平均有限。使用与绩效变化之间的积极关联表明，政策制定者应增加对实践/QI努力的支持。这种支持可以包括为数据的对等组讨论提供形式化的结构，促进对数据和可能的行动点的理解，以提高性能，同时保持专业主导的应用程序使用。
方法：我们在长达5年的时间内研究了122项初级保健实践\'访问页面（页面视图）的纵向数据。我们比较了高用户和低用户，按每月平均页面浏览量分类，关于实践和患者特征以及性能指标子集的基线测量。我们估计了在1.5年内，对具有糖尿病相关指标的页面的访问与所选糖尿病指标的测量变化之间的线性关联。
结果：在给定月份中，不到一半的所有实践访问了数据，尽管大多数实践在至少三分之一的观察月份访问了数据。就研究最多的特征而言，高用户和低用户相似。我们发现糖尿病指标的使用与三个糖尿病指标的测量变化之间存在统计学上的显着正相关。
结论：尽管本研究中的大多数实践表明对自动反馈报告感兴趣，使用强度可以描述为变化和平均有限。使用与绩效变化之间的积极关联表明，政策制定者应增加对实践/QI努力的支持。这种支持可以包括为数据的对等组讨论提供形式化的结构，促进对数据和可能的行动点的理解，以提高性能，同时保持专业主导的应用程序使用。
