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Evaluating the quality of care for patients with type 2 diabetes using electronic medical record information in Mexico

This study assesses the quality of care provided to patients with type 2 diabetes in Mexico using electronic medical record (EMR) information. It validates the data in the EMR system and develops indicators to evaluate the quality of diabetes care. The study highlights the feasibility of using EMR data to measure quality of care and suggests areas for improvement in both care and EMR completion.

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Evaluating the quality of care for patients with type 2 diabetes using electronic medical record information in Mexico

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  1. Evaluating the quality of care for patients with type 2 diabetes using electronic medical record information in Mexico 1Epidemiology and Health Services Research Unit at InstitutoMexicano del Seguro Social; 2 Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute; 3Centre for Health Services and Policy Research, The University of British Columbia, Canada. Ricardo Pérez-Cuevas,1 Svetlana Doubova,1 Michael Law,3 Aakanksha Pande,2Magdalena Suárez,1 Dennis Ross-Degnan,2 Anita Wagner,2.

  2. PROBLEM STATEMENT • Affecting 14% of the Mexican population, type 2 diabetes (T2D) is the most common chronic condition seen at Mexican Institute of Social Security (IMSS) family medicine clinics (FMC), and among the top causes of hospital admissions and death. • In 2003, IMSS introduced an electronic medical record (EMR) system in its 1,400 FMC serving 48 million people. This study is the first to evaluate quality of care (QC) using data from the IMSS EMR and associated electronic pharmacy and laboratory databases.

  3. OBJECTIVES • To validate data in the IMSS EMR and to test the feasibility of structuring extracted EMR and other electronic data. • To develop indicators and evaluate the quality of diabetes care provided in IMSS clinics based on electronic EMR and other data

  4. METHODS Design: The study used a mixed method approach consisting of : a) development of quality of care indicators for T2D using the RAND-UCLA method; b) evaluation of the feasibility to extract and process EMR data; and c) evaluation of QC for T2D. Setting: 39 FMCs in Mexico City. Study Population: Patients with T2D who received care in 2009. Outcome Measure(s): We developed and tested fourteen QC indicators including indicators of prescription drug use (metformin, statins, angiotensin converting enzyme inhibitors (ACEI) and acetylsalicylic acid (ASA)); nutritional counseling; foot evaluation; orders of blood glucose and total cholesterol measurements; outcome indicators were blood glucose, blood pressure, and total cholesterol control and body weight.

  5. Table 1. Population and characteristics of family medicine clinic

  6. Table 2. Type 2 diabetes patients general characteristics

  7. Table 3. Clinical conditions and health care characteristics

  8. Table 4. Quality of care indicators

  9. Table 4. Quality of care indicators

  10. CONCLUSIONS • This pilot study demonstrated that it is feasible to evaluate QC using the IMSS EMR data. It highlighted needs for improvement of both QC and the completion of information in the EMR in IMSS. • Measuring QC in this way, can identify the performance of individual clinics or single providers and guide future interventions aimed at improving QC. IMSS is a large organization that has the potential to attain the expected benefits of its EMR, such as improving clinical efficiency and measuring quality and safety of healthcare; otherwise the EHR would be cost-ineffective.

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