Measuring Cardiovascular Quality in Primary Care Using Canadian Cardiovascular Harmonization of National Guidelines Endeavour and Electronic Medical Record Data in Ontario

BACKGROUND: This project uses electronic medical record (EMR) data to assess performance by family physicians (FPs) in the screening for, diagnosis, and management of cardiovascular disease (CVD) and risk factors against national harmonized guidelines by the Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE). METHODS: A retrospective cohort study using the Electronic Medical Record Administrative Data Linked Database (EMRALD) was conducted. A set of quality indicators (QIs) were developed on the basis of the 2014 C-CHANGE guidelines. Twenty-three readily measurable QIs were used to measure performance in the screening for and management of CVD, and to identify gaps in performance. RESULTS: Our study population consisted of 324 Ontario FPs and 284,959 patients. We assessed 23 of the 74 recommendations. There was variance in rates of adherence to QIs related to screening rates for CVD. Highest adherence to C-CHANGE guidelines was related to laboratory testing for patients with hypertension and prescription of antihypertensive therapies (≥ 91.4%). Lowest adherence to the guidelines was seen in administration of oral glucose tolerance tests for assessing prediabetic patients (4.4%). CONCLUSIONS: FP EMR data can be used to measure adherence to one-third of the C-CHANGE recommendations. There are varying levels of adherence among the measurable C-CHANGE recommendations, and there is room for improvement in quality of primary care management of CVD in Ontario. There is potential to use EMR data to assess changes to CVD management in FP practice using guidelines if recommendations are quantifiable and measurable.