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VBCR - April 2016, Vol 5, No 2 - Canadian Rheumatology Association Annual Meeting
Rosemary Frei, MSc

Lake Alberta—Researchers are taking incremental steps to extract data from electronic medical records (EMRs) to assess whether patients with gout are being treated appropriately.

Recently, investigators demonstrated the feasibility of gathering data on several key gout treatment quality indicators from EMRs.1 Using 10 quality indicators for gout care established more than a dozen years ago,2 they found that although some quality indicators are easy to assess with EMRs, others are difficult.

“An important implication of this study is that we demonstrated it is feasible to operationalize quality indicators into EMR variables, and that the data are highly available in EMRs, beyond basic capture/storage of patient information,” noted lead investigator Mary A. De Vera, PhD, Assistant Professor, Medication Adherence, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Research Scientist, Arthritis Research Centre of Canada, Richmond, Vancouver, and colleagues.

To determine how to use EMR data to monitor how well patients with gout are being managed, the investigators evaluated the 10 accepted quality indicators, which include the use of urate-lowering therapy, lifestyle modifications and anti-inflammatory medications. Their goal was to help reduce the well-documented, frequent mismanagement of patients with gout.

A total of 125 patients with diagnostic codes indicative of gout, tophaceous gout, tophaceous deposits, or uric acid nephrolithiasis per the International Classification of Diseases, Ninth Revision, were treated between January 1, 2012, and December 31, 2013.

The researchers’ first steps were to translate each of the 10 quality indicators into key variables, and check these variable sets for completeness. The team then extracted anonymized patient data from the EMRs that related to any of the quality indicator variables; this allowed them to determine whether there was enough information in the EMRs to evaluate each of the quality indicators.

For 6 of the 10 quality indicators, ≥69% of the EMRs had sufficient data available for assessment. These included the quality indicators of having an allopurinol dose <300 mg/day in patients with gout and renal impairment, or receipt of xanthine oxidase inhibitors instead of uricosuric agents by patients with gout and renal insufficiency or nephrolithiasis; both of which involved searching the EMRs for data on serum creatinine/creatinine clearance and allopurinol prescriptions.

One quality indicator was associated with only an 8% rate of appropriate-data extraction; this was the single quality indicator related to lifestyle changes—specifically, receipt of counseling or other methods for improving elevated body mass index or alcohol use.

The researchers found that assessing the remaining 3 quality indicators using EMR data was not feasible. These quality indicators included halving any azathioprine and 6-mercaptopurine prescriptions of patients receiving xanthine oxidase inhibitor prescriptions, and giving hyperuricemic patients with gouty arthritis—characterized by tophi, erosive changes on radiographs, or ≥2 gout attacks annually—urate-lowering therapy.

The next steps proposed by the investigators are attempting to extract gout quality indicator data from EMRs at the community-practice level, and evaluating whether this improves patient care and outcomes.




References

  1. Estrada AJ, Tsao NW, Galo JS, et al. Assessing gout quality indicators in electronic medical records: a feasibility study. Poster presented at: 2016 Canadian Rheumatology Association Annual Scientific Meeting; February 17-20, 2016; Lake Louise, Alberta.
  2. Mikuls TR, MacLean CH, Olivieri J, et al. Quality of care indicators for gout management. Arthritis Rheum. 2004;50:937-943.
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