ChronoMedIt--a computational quality audit framework for better management of patients with chronic conditions

Quality audit and feedback to general practice is an important aspect of successful chronic disease management. However, due to the complex temporal relationships associated with the nature of chronic illness, formulating clinically relevant queries within the context of a specific evaluation period is difficult.

We abstracted requirements from a set of previously developed criteria to develop a generic criteria model that can be used to formulate queries related to chronic condition management. We implemented and verified the framework, ChronoMedIt, to execute clinical queries within the scope of the criteria model.

Our criteria model consists of four broad classes of audit criteria - lapse in indicated therapy, no measurement recording, time to achieve target and measurement contraindicating therapy. Using these criteria classes as a guide, ChronoMedIt has been implemented as an extensible framework. ChronoMedIt can produce criteria reports and has an integrated prescription and measurement timeline visualisation tool. We illustrate the use of the framework by identifying patients on suboptimal therapy based on a range of pre-determined audit criteria using production electronic medical record data from two general medical practices for 607 and 679 patients with hypertension. As the most prominent result, we find that 59% (out of 607) and 34% (out of 679) of patients with hypertension had at least one episode of >30day lapse in their antihypertensive therapy over a 12-month evaluation period.

ChronoMedIt can reliably execute a wide range of clinically useful queries to identify patients whose chronic condition management can be improved.