Mequal-heart record in combination with the Heart Manual

Transkript

1 Mequal-heart record in combination with the Heart Manual Hans Tygesen, MD, PhD Head of Cardiology Department of Medicine SÄS International forum on quality and safety in healthcare

2 The Heart Manual Local guidelines for heart disease treatment Yearly update, now 230 pages Everyone can contribute National and european latest guidelines included

3 Mequal-MEdical QUALity or Medical EQUALity Computerized decision & workflow support in Cardiology

4 History

5 Demands of documentation increases Notes for personal use Information shared with other care givers Legal document

6 History

7 Computerised record Text based; computerised paper record Simple-dictate as usual

8 Example Risk profile: Known hypertension. No Keywords hyperlipidemia. Smokes 15 cigarettes daily. Moderate alcohol consumption. Blood pressure: 140/90. Uncoordinated text

9 Personal background Clinical active cardiologist Research; PhD and international multicenter trails Recording study patient CRF

10 Heart record 2003 Standard care plan for ischemic heart disease Including clinical physiology and procedures Process oriented Quality registries as templates Data stored atomically Counteracting redundant data

11 Heart record 2003 Quality check» Compulsory data» Check for completeness Possibility for searching data Quality check of data exported to quality registries Decision support QUICC

12 Export to the quality registry of myocardial infarction 4 pages, about 110 entries for each patient

13 Decision support QUICC A national quality insurance project 5 treatments/procedures were selected ACE-inhibitors, lipid lowering treatment, clopidogrel, LMVheparin, coronary angiography

14 ACE-inhibitor treatment Systolic heart failure Clinical signs of heat failure Diabetes Hypertension

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17 Borås Quicc-results Before and after decision support ACE-hämmarbehandling 100% 80% 60% 40% 20% 0% Före Fått avsedd behandling Efter Ej fått behandling

18 Borås Quicc-results Before and after decision support ACE-hämmarbehandling 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Före Efter Fått avsedd behandling Fått avsedd beh, ej registrerad Kontraindikation föreligger Ej fått behandling

19 Borås Quicc-results Before and after decision support

20 Accordance to guidelines in Västra Götaland % 90% 80% 70% 60% 50% Borås Övriga VG 40% 30% 20% 10% 0% jan-02 jan-03 jan-04 jan-05 jan-06 jan-07 jan-08

21 Gender differenses in treatment are reduced when using decision support? In a recently published paper we demonstrated less accordence to guidelines when treating women in the Western region We do not see those differences in data from Borås for ACE-inhibitors

22 Hazards / limitations using decision support Users have to be well informed and accepting guidelines More difficult to apply when several groups are involved More difficult to apply when the decision process is taking some time Treatment changes can be done fast- dangerous if the new treatment turns out to be harmfull

23 Futher development Regional project Developing standard care planes for other diseases as atrial fibrillation, heart failure and pneumonia Online-export to quality registry RIKS-HIA New decision support for atrial fibrillation and heart failure

24 Standard care plan for myocardial infarction

25 Exportapp RIKS-HIA

26 New decision supports Heart failure New heart failure treatment 94-98% adherence Atrial fibrillation Anticoagulation

27 Anticoagulation in atrial fibrillation

28 Future Futher regional development has stopped last year Mequal is used in Borås A lot of quality data is being extracted and analysed; to become better we have to know how we are performing to day!

29 Thank you! References Clinical decision support system (CDSS)--effects on care quality. dos Santos MA, Tygesen H, Eriksson H, Herlitz J. Int J Health Care Qual Assur. 2014;27(8): Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Redfors B, Angerås O, Råmunddal T, Petursson P, Haraldsson I, Dworeck C, Odenstedt J, Ioaness D, Ravn-Fischer A, Wellin P, Sjöland H, Tokgozoglu L, Tygesen H, Frick E, Roupe R, Albertsson P, Omerovic E. J Am Heart Assoc Jul 14;4(7). pii: e doi: /JAHA