Journal of Public Health 26(1) © Faculty of Public Health 2004; all rights reserved.
An educational intervention to improve data recording in the management of ischaemic heart disease in primary care
Simon de Lusignan, Senior Lecturer
Nigel Hague, Research Fellow
Adrian Brown, Senior Clinical Research Fellow
Primary Care Informatics, Department of General Practice and Primary Care, St. George's Hospital Medical School, London SW17 0RE
Azeem Majeed, Professor of Primary Care & Public Health
School of Public Policy, University College London, London WC1H 9QU
Address correspondence to Dr Simon de Lusignan. E-mail: slusigna{at}sghms.ac.uk
Background Gaps in computerized medical records and a lack of a systematic approach to data recording make progress towards achieving quality standards in primary care difficult to demonstrate. The aim of this study was to examine the effect of an educational intervention on data quality in primary care.
Methods A before-and-after study of key data quality measures was carried out in 87 general practices in eight primary care organizations in England in phase 1 and 84 general practices in phase 2. The subjects were 19470 patients with ischaemic heart disease in phase 1 and 19784 patients in phase 2. The main outcome measures were improvement in the completeness and quality of the computerized medical record. Anonymized data were extracted from clinical information systems and processed to produce comparative information on each practice. Data quality workshops were arranged, in which reflection can take place, backed up by summary statistics. Practice visits provided training and personalized feedback of patients needing intervention.
Results In the patients with heart disease, nearly 16000 new clinical entries were made in the key improvement areas. The percentage of patients advised to quit smoking increased by 49.3 per cent, from 23.6 per cent to 61.9 per cent. There were also significant improvements in many other aspects of management.
Conclusion Focused interventions that provide targeted and relevant clinical information can be implemented in primary care. Such interventions can lead to a rise in data quality in primary care, but their effectiveness needs to be further tested in more rigorous research settings such as randomized controlled trials.
Keywords: primary care, quality improvement, secondary prevention of coronary heart disease, computerized medical records
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