The Department of Veterans Affairs is using electronic health record data to assess the quality of care for patients who have experienced a transient ischemic attack, or mini-stroke, effectively replacing labor-intensive and expensive manual chart reviews, the current gold standard for tracking these medical incidents.

What the VA has found is that the quality of TIA care can be accurately measured from the EHR, which is critical for the agency in identifying potential areas of improvement and in reducing the likelihood that patients will experience subsequent strokes.

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Dawn Bravata, MD, a Regenstrief Institute investigator, led the first national study to investigate the feasibility of assessing and reliably measuring quality of care following mini-stroke by leveraging EHR data.

“Not so much work has been done evaluating TIA care using electronic quality measures,” says Bravata, who is also an Indiana University School of Medicine professor of clinical medicine and a core investigator with the VA Health Services Research and Development Center for Health Information and Communication.

For the study, researchers developed 31 electronic quality measures using EHR data, with chart review serving as the criterion standard for validating the eQMs.

“We looked to see whether the two approaches—chart review and EHR data—agreed on whether the patient was eligible for specific care interventions, for example brain imaging or statin medication, and if applicable, whether the two approaches agreed on whether the patient actually received the care,” according to Bravata.

While the data from the paper charts and EHR did not always agree across the processes of care and the study found some variations, she relates there were other areas where the agreement was superb. At the same time, Bravata notes there were data in the EHR deemed just as good—if not better—than the data in the chart review, such as blood pressure control.

“Healthcare systems with EHRs should consider using electronic data to evaluate care for their patients with transient ischemic attack and to complement and expand quality measurement programs currently focused on patients with stroke,” concludes the study, which was published recently in Circulation: Cardiovascular Quality and Outcomes.

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