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Development and Validation of Quality Measures for Testosterone Prescribing
Ann M Borzecki1,2,3, Jennifer Conti1, Joel I Reisman1
1Center for Healthcare Organization & Implementation Research, Bedford Site, VA Bedford Healthcare System, Bedford, MA 01730, USA.
Journal of the Endocrine Society
|June 26, 2023
Summary
New quality measures accurately assess testosterone prescribing. These electronic health record (EHR)-based tools can identify gaps and improve care for men with hypogonadism.
Area of Science:
- Endocrinology
- Health Services Research
- Medical Informatics
Background:
- Improving testosterone prescribing practices requires accurate assessment tools.
- Current methods for evaluating testosterone prescription appropriateness are lacking.
Purpose of the Study:
- To develop and validate quality measures for the initiation and monitoring of testosterone therapy.
- To create reliable indicators for assessing testosterone prescribing practices.
Main Methods:
- Retrospective cohort study of male patients initiating testosterone in the Veterans Health Administration (VA).
- Development of 16 quality measures (9 initiation, 7 monitoring) using VA electronic health record (EHR) data, Endocrine Society guidelines, and expert opinion.
- Criterion validity assessed via manual chart review of 142 patients, calculating positive predictive values (PPVs), negative predictive values (NPVs), overall accuracy (OA), and Matthews Correlation Coefficients (MCCs).
Main Results:
- 10 measures based on laboratory data demonstrated high validity (PPVs >78%, NPVs >98%, OA ≥94%, MCCs >0.85).
- 6 measures using diagnostic codes showed excellent NPVs (100%) and OAs (≥98%).
- Lower PPVs were observed for measures related to acute conditions (myocardial infarction, stroke) and new diagnoses (prostate, breast cancer) due to low case numbers.
Conclusions:
- Validated electronic health record (EHR)-based quality measures for testosterone prescribing have been developed.
- These measures can be deployed to identify quality gaps in testosterone prescribing.
- Implementation of these measures can lead to improved care for men with hypogonadism.
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