Medical records and quality of care in acute coronary syndromes

Results from CRUSADE

Shannon M Dunlay, Karen P. Alexander, Chiara Melloni, Jennifer L. Kraschnewski, Li Liang, W. Brian Gibler, Matthew T. Roe, E. Magnus Ohman, Eric D. Peterson

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Patient medical records are important means of communication among health care providers. Limited evaluation has been performed of the quality of the medical records or its association with health care processes or outcomes. Methods: We performed an empirical evaluation of the completeness of medical records from 607 randomly selected patients admitted with non-ST-segment elevation acute coronary syndromes (NSTE ACS) to 219 US hospitals in the CRUSADE National Quality Improvement Initiative. Composite medical records scores were summated and compared by hospital academic status and physician specialty. Correlations between medical records scores, use of evidence-based medicine (EBM), and in-hospital mortality were assessed. Results: Medical records were frequently missing key elements, including cardiac history (23.6%), performance status (64.6%), differential diagnosis (57.8%), and planned use of EBM (44.0%). Evidence-based medicine was more often discussed in medical records from academic medical centers vs nonacademic medical centers (69.7% vs 51.7%) (P<.001) and from cardiologists vs noncardiologists (60.5% vs 48.1%, P=.003). Higher medical records quality scores were associated with greater use of EBM among the medical records quality cohort (P=.006), and a similar trend was observed in CRUSADE overall: adjusted odds ratio, 1.26 (95% confidence interval, 0.92-1.72) for high vs low medical records quality. Higher medical records quality scores were associated with lower in-hospital mortality: adjusted odds ratio, 0.79 (95% confidence interval, 0.65-0.97). Conclusions: Medical records for patients with NSTE ACS often lack key elements of the history and physical examination. Patients treated at hospitals with better medical records quality have significantly lower mortality and may receive more EBM. The relationship between better medical charting and better medical care could lead to new ways to monitor and improve the quality of medical care.

Original languageEnglish (US)
Pages (from-to)1692-1698
Number of pages7
JournalArchives of Internal Medicine
Volume168
Issue number15
DOIs
StatePublished - Aug 25 2008
Externally publishedYes

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Quality of Health Care
Acute Coronary Syndrome
Medical Records
Evidence-Based Medicine
Hospital Mortality
History
Odds Ratio
Confidence Intervals
Quality Improvement
Health Personnel
Physical Examination
Differential Diagnosis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Dunlay, S. M., Alexander, K. P., Melloni, C., Kraschnewski, J. L., Liang, L., Gibler, W. B., ... Peterson, E. D. (2008). Medical records and quality of care in acute coronary syndromes: Results from CRUSADE. Archives of Internal Medicine, 168(15), 1692-1698. https://doi.org/10.1001/archinte.168.15.1692

Medical records and quality of care in acute coronary syndromes : Results from CRUSADE. / Dunlay, Shannon M; Alexander, Karen P.; Melloni, Chiara; Kraschnewski, Jennifer L.; Liang, Li; Gibler, W. Brian; Roe, Matthew T.; Ohman, E. Magnus; Peterson, Eric D.

In: Archives of Internal Medicine, Vol. 168, No. 15, 25.08.2008, p. 1692-1698.

Research output: Contribution to journalArticle

Dunlay, SM, Alexander, KP, Melloni, C, Kraschnewski, JL, Liang, L, Gibler, WB, Roe, MT, Ohman, EM & Peterson, ED 2008, 'Medical records and quality of care in acute coronary syndromes: Results from CRUSADE', Archives of Internal Medicine, vol. 168, no. 15, pp. 1692-1698. https://doi.org/10.1001/archinte.168.15.1692
Dunlay, Shannon M ; Alexander, Karen P. ; Melloni, Chiara ; Kraschnewski, Jennifer L. ; Liang, Li ; Gibler, W. Brian ; Roe, Matthew T. ; Ohman, E. Magnus ; Peterson, Eric D. / Medical records and quality of care in acute coronary syndromes : Results from CRUSADE. In: Archives of Internal Medicine. 2008 ; Vol. 168, No. 15. pp. 1692-1698.
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abstract = "Background: Patient medical records are important means of communication among health care providers. Limited evaluation has been performed of the quality of the medical records or its association with health care processes or outcomes. Methods: We performed an empirical evaluation of the completeness of medical records from 607 randomly selected patients admitted with non-ST-segment elevation acute coronary syndromes (NSTE ACS) to 219 US hospitals in the CRUSADE National Quality Improvement Initiative. Composite medical records scores were summated and compared by hospital academic status and physician specialty. Correlations between medical records scores, use of evidence-based medicine (EBM), and in-hospital mortality were assessed. Results: Medical records were frequently missing key elements, including cardiac history (23.6{\%}), performance status (64.6{\%}), differential diagnosis (57.8{\%}), and planned use of EBM (44.0{\%}). Evidence-based medicine was more often discussed in medical records from academic medical centers vs nonacademic medical centers (69.7{\%} vs 51.7{\%}) (P<.001) and from cardiologists vs noncardiologists (60.5{\%} vs 48.1{\%}, P=.003). Higher medical records quality scores were associated with greater use of EBM among the medical records quality cohort (P=.006), and a similar trend was observed in CRUSADE overall: adjusted odds ratio, 1.26 (95{\%} confidence interval, 0.92-1.72) for high vs low medical records quality. Higher medical records quality scores were associated with lower in-hospital mortality: adjusted odds ratio, 0.79 (95{\%} confidence interval, 0.65-0.97). Conclusions: Medical records for patients with NSTE ACS often lack key elements of the history and physical examination. Patients treated at hospitals with better medical records quality have significantly lower mortality and may receive more EBM. The relationship between better medical charting and better medical care could lead to new ways to monitor and improve the quality of medical care.",
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AU - Liang, Li

AU - Gibler, W. Brian

AU - Roe, Matthew T.

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