Method for developing national quality indicators based on manual data extraction from medical records

Abstract

Developing quality indicators (QI) for national purposes (eg, public disclosure, paying-for-performance) highlights the need to find accessible and reliable data sources for collecting standardised data. The most accurate and reliable data source for collecting clinical and organisational information still remains the medical record. Data collection from electronic medical records (EMR) would be far less burdensome than from paper medical records (PMR). However, the development of EMRs is costly and has suffered from low rates of adoption and barriers of usability even in developed countries. Currently, methods for producing national QIs based on the medical record rely on manual extraction from PMRs. We propose and illustrate such a method. These QIs display feasibility, reliability and discriminative power, and can be used to compare hospitals. They have been implemented nationwide in France since 2006. The method used to develop these QIs could be adapted for use in large-scale programmes of hospital regulation in other, including developing, countries.

Figure 1

Variability in score for ‘quality and content of the medical record’, ‘traceability of pain assessment’ and ‘time elapsed before sending discharge letters’ during pilot testing. The horizontal line gives the mean score for each hospital (with 95% CI). The vertical line represents the overall mean score for all hospitals. The number and percentage of hospitals in each ranking category are given.