Measuring the process of quality of care for ST-segment elevation acute myocardial infarction through data-mining of the electronic discharge notes.

摘要

BACKGROUND: Measuring parameters in the management of acute myocardial infarction (AMI) has been used as the standard for evaluating quality of care (QC). The purpose of this study was to elucidate the completeness of information retrieval from electronic discharge notes (EDN) as well as to measure QC for AMI in Taiwan. METHODS: All the narrative reports in EDN in the clinical information systems (CIS) of National Taiwan University Hospital from 2002 to 2004 were retrieved, and the patients who presented to the emergency room (ER) with AMI were identified. Ten parameters related to QC for AMI were measured through data-mining of EDN alone as well as through an extensive search of the CIS and paper medical records. RESULTS: Information retrieval from EDN alone could obtain some parameters with a high recall, such as the use and timing of reperfusion therapy and the prescription of medication at discharge. Other parameters, such as the early management at ER and lipid profile after discharge, could not be retrieved from EDN. The use of medication and early reperfusion therapy was comparable to the US standards, while lipid control at and after discharge were suboptimal. CONCLUSIONS: This study has demonstrated that information retrieval from EDN alone could faithfully extract sufficient measures of QC for AMI in some aspects, as well as could quantify the current process of QC for AMI in Taiwan.