缺乏标准化的编码限制了肺栓塞诊断电子临床质量测量的准确性
Lisa Baumann Kreuziger1,2, Megan Keenan3, Hayley Dykhoff3
1Medical College of Wisconsin, Milwaukee, WI.
概括
发展肺栓塞 (PE) 诊断的电子质量测量是具有挑战性的,因为计算机断层扫描肺血管造影 (CTPA) 和D-二次测试在医疗保健系统中的编码不一致.
科学领域:
- 医疗信息学 医疗信息学
- 医疗质量测量 医疗质量测量
- 诊断成像 诊断成像 诊断成像
背景情况:
- 肺栓塞 (PE) 诊断指南建议在D-二分体测试或计算机断层扫描肺血管造影 (CTPA) 之前进行预测概率 (PTP) 评估.
- 电子临床质量测量 (eCQM) 旨在标准化护理,但需要准确的数据捕获用于诊断测试.
- 开发用于PE诊断的eCQM受阻于使用标准代码识别CTPA和D-二次测试的变化.
研究的目的:
- 为在eCQM中开发用于识别CTPA和异常D-二次体试验的值集.
- 在多个医疗保健系统中评估用于捕获PE诊断测试的标准化代码的准确性.
- 评估基于PTP风险的适当CTPA排序创建eCQM的可行性.
主要方法:
- 审查了目前的程序术语 (CPT),逻辑观察标识符名称和代码 (LOINC) 和医学临床术语系统化命名法 (SNOMED CT) 代码在三个学术医疗保健系统.
- 确定了使用综合和限制值集的CTPA程序,计算灵敏度,特异性和正预测值 (PPV).
- 通过使用可用的代码评估了D-二聚体测试和异常结果的识别.
主要成果:
- 一个全面的CTPA值集具有较低的PPV (63.4%).
- 将CTPA值设置为CPT代码71275或LOINC 88322-3的限制将PPV显著提高到82%,具有高灵敏度 (100%) 和特异性 (99%).
- 在D-二次体测试和异常结果的编码中发现了显著的异质性,SNOMED CT没有用于高D-二次体结果.
结论:
- 目前对CTPA和D-二次体检测的标准化值集缺乏必要的准确性和一致性,以开发用于PE诊断的强大的eCQM.
- 虽然有限的CTPA值集显示出有希望的结果,但在识别异常D-二次元结果方面的局限性阻止了eCQM的开发,以评估适当的测试订单.
- 进一步规范实验室和成像测试的编码对于医疗保健中的有效质量测量至关重要.
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