Implementing Health Care Quality Measures in Electronic Health Records: A Conceptual Model

J Am Geriatr Soc. 2021 Apr;69(4):1079-1085. doi: 10.1111/jgs.17033. Epub 2021 Jan 19.


Background/objectives: There is significant literature on the development and validation of quality measures, but comparably less on their implementation into learning health systems. Electronic Health Records (EHRs) have made vast amounts of data available for quality improvement purposes. In this paper we describe a conceptual model for EHR implementation of quality measures.

Design: The model involves five steps: (1) select a measure; (2) define measure criteria; (3) validate criteria and measurement process; (4) improve recording of measure-related activity; and (5) engage quality improvement processes. The model was used to develop and implement a quality measure in the Home-Based Medical Care (HBMC) setting.

Setting: Harris Health House Call Program (HHHC) provides primary medical and palliative care for homebound patients in Houston.

Participants: Four-hundred twenty-four primary care patients followed in the HHHC.

Measurement: Completion rate of the 9-item Patient Health Questionnaire (PHQ-9) within the Electronic Health Record of newly enrolled HHHC patients.

Results: Use of the conceptual model to guide implementation of a quality measure of depression screening in a HMBC practice was successful. Additional components of early leadership and clinician buy-in were required, as well as strong relationships with IT to ease implementation and limit disruptions in clinicians' work-flow.

Conclusion: This conceptual model was feasible for guiding implementation of a quality measure for depression care of HBMC patients, and it can guide broader implementation of EHR-based quality measures in the future.

Keywords: Electronic Health Records; health information technology; medical informatics.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Depression / diagnosis*
  • Electronic Health Records* / standards
  • Electronic Health Records* / statistics & numerical data
  • Female
  • Home Care Services / standards*
  • Homebound Persons / psychology
  • Homebound Persons / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / methods
  • Mass Screening / standards
  • Medical Informatics / methods
  • Palliative Care / methods
  • Palliative Care / standards
  • Primary Health Care / methods
  • Primary Health Care / standards
  • Quality Assurance, Health Care / methods*
  • Quality of Health Care / organization & administration

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