Greg Twyford wrote: > Colleagues, > > This from recent PHCRIS conference: > > <http://www.phcris.org.au> > > > GP & PHC Research Conference Abstracts 2007 > > Effect of computerisation on quality of general practice care—a > comparison with quality indicators
I suspect that this study may fall foul of the "ecological fallacy" - that is, the analysis is of aggregate measures of care (eg how many HbA1cs are done on each GP's set of patients) but it is drawing conclusions about the quality of individual patient care. Such analyses are prone to potentially misleading mistakes (I should know, because I am guilty of many such studies and analyses myself - mea culpa!). What is really required is a multilevel analysis, in which indicators of the appropriateness of care for each individual patient are included in the statistical model together with group level variables indicating each GP's computer use and so on. I am not sure whether the BEACH survey data is detailed enough (that is, is it collected at the individual patient level) to permit such an analysis. This paper suggests that BEACH does in fact collect individual patient data, and thus a multilevel analysis should be possible: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=545648 Of course, ecological analysis in which groups (eg all patients cared for by a particular GP) are assumed to be homogenous is easier to do and the results are not necessarily wrong, but must be interpreted with caution. It would be interesting if the data were re-analysed using a multi-level model, with the individual patient data as the lowest level of covariates, and the characteristics of their GP (including computer use) as the second level of covariates. Unless, of course, the authors of the study already did that, but looking at their presentation, I don't think they did. Tim C > Author(s) > > Joan Henderson > <http://www.phcris.org.au/elib/browse.php?search=Joan+Henderson>, Graeme > Miller <http://www.phcris.org.au/elib/browse.php?search=+Graeme+Miller>, > Helena Britt > <http://www.phcris.org.au/elib/browse.php?search=+Helena+Britt>, Ying > Pan <http://www.phcris.org.au/elib/browse.php?search=+Ying+Pan> > Organisation > > Family Medicine Research Centre, University of Sydney > Objectives > > There is an assumption expressed in literature that computer use for > clinical activity will improve quality of general practice care, but > with little evidence to support or refute this assumption. This study > compares GPs using a computer to prescribe, order tests, or keep patient > records, with GPs who do not, using a set of validated quality > indicators. > Methods > > BEACH (Bettering the Evaluation and Care of Health) is a continuous > national cross-sectional survey of general practice activity in > Australia. A sub-sample of 1257 BEACH participants between November 2003 > and March 2005 were grouped according to their computer use for: test > ordering, prescribing, and/or medical records. Linear regression > analysis was used to compare the two groups on a set of 33 quality > indicators. > Principal Findings > > The univariate analysis showed that computerised GPs managed more > problems; provided fewer medications; ordered more pathology tests; > performed more Pap smears; provided more immunisations; ordered more > HbA1c tests and provided more referrals to ophthalmologists and allied > health workers for diabetes patients; and provided less lifestyle > counselling. After adjustment, the only differences that could be > contributed solely to computer use were prescribed medication rates, > lifestyle counselling and referrals to ophthalmologists. Two other > differences emerged—computerised GPs provided more referrals for allied > health workers for all patients, and fewer prescribed anti-depressants > for patients with depression. Twenty-two measures failed to discriminate > before or after adjustment. > Discussion > > Deciding ‘best quality’ is subjective. While literature and guidelines > provide clear parameters for many measures, others are difficult to > judge. Only five differences were directly related to computer > use—computerised GPs performed better on four measures and worse on one. > Overall, there was little difference between the two groups. > Implications > > This study has found little evidence to support the claim that > computerisation of general practice in Australia has changed the quality > of care provided to patients. > Presentation > > Open document. <javascript: > openDoc('/phplib/filedownload.php?file=/elib/lib/downloaded_files/conference/presentations/3700_JoanHende.pdf');> > > PDF 563.5 Kb > > Copyright © 2007 Primary Health Care Research and Information Service. > Copyright & Disclaimer information > <http://www.phcris.org.au/website/copyright_wd.php> > > <http://www.phcris.org.au/images/logo/minilogo.gif> > www.phcris.org.au <http://www.phcris.org.au> > > Greg _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
