OBJECTIVE: To study relationship between institutional process indicators (measured using electronic records) and intermediate outcomes of patients with hypertension. DESIGN: Cross-sectional epidemiological study. SETTING: Primary Care Health District 1. Madrid. 2010. PATIENTS: All patients with hypertension. n=80,306. MAIN MEASUREMENTS: 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.
OBJECTIVE: To study relationship between institutional process indicators (measured using electronic records) and intermediate outcomes of patients with hypertension. DESIGN: Cross-sectional epidemiological study. SETTING: Primary Care Health District 1. Madrid. 2010. PATIENTS: All patients with hypertension. n=80,306. MAIN MEASUREMENTS: 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: Judith M E Walsh; Kathryn M McDonald; Kaveh G Shojania; Vandana Sundaram; Smita Nayak; Robyn Lewis; Douglas K Owens; Mary Kane Goldstein Journal: Med Care Date: 2006-07 Impact factor: 2.983
Authors: José R Banegas; Albert Jovell; Benjamín Abarca; Manuel Aguilar Diosdado; Luis Aguilera; Pedro Aranda; Vicente Bertoméu; Pedro Capilla; Pedro Conthe; Fernando De Alvaro; Antonio Fernández-Pro; Xavier Formiguera; Jesús Frías; Lucía Guerrero; José L Llisterri; José M Lobos; Juan F Macías; Angel L Martín De Francisco; Jesús Millán; Juan C Morales; Vicente Palomo; Alex Roca-Cusachs; Javier Román; Carlos Sanchis; Antonio Sarriá; Julián Segura; Alex De La Sierra; Luis Verde; Julio Zarco; Luis M Ruilope Journal: Med Clin (Barc) Date: 2009-02-12 Impact factor: 1.725
Authors: A Dalfó Baqué; A Sisó Almirall; M A Vila Coll; S Núñez Vázquez; M Botinas Martí; E Gibert Llorach Journal: Aten Primaria Date: 2000-12 Impact factor: 1.137
Authors: Nicolas Rodondi; Tiffany Peng; Andrew J Karter; Douglas C Bauer; Eric Vittinghoff; Simon Tang; Daniel Pettitt; Eve A Kerr; Joe V Selby Journal: Ann Intern Med Date: 2006-04-04 Impact factor: 25.391
Authors: Aram V Chobanian; George L Bakris; Henry R Black; William C Cushman; Lee A Green; Joseph L Izzo; Daniel W Jones; Barry J Materson; Suzanne Oparil; Jackson T Wright; Edward J Roccella Journal: JAMA Date: 2003-05-14 Impact factor: 56.272
Authors: Steven M Asch; Elizabeth A McGlynn; Liisa Hiatt; John Adams; Jennifer Hicks; Alison DeCristofaro; Roland Chen; Pablo LaPuerta; Eve A Kerr Journal: BMC Cardiovasc Disord Date: 2005-01-07 Impact factor: 2.298