The use of an automated patient registry to manage and monitor cardiovascular conditions and related outcomes in a large health organization

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Abstract

Background

The present study describes a computerized registry of cardiovascular disease patients in a large health maintenance organization in Israel. The registry is aimed to be used by health professionals to identify cardiovascular disease patients and to follow the courses of their illnesses and risk factors.

Methods

In 1998, the registry was initiated using advanced information technology that integrated personal computerized community and hospital records, data from laboratory tests, dispensed medications, physiological signals, radiological images, and reports from investigations and procedures.

Results

Between 1998 and 2007, the number of patients with cardiovascular diseases that were identified by the registry has increased from 34,144 to 80,339. During this period, the age-adjusted prevalence rates have risen from 3.7% to 5.1% and from 1.9% to 2.6%, among men and women, respectively. The percentage of ischemic heart disease patients who reached target LDL was doubled, from 21% in 2000 to 50% in 2006. The average stay in hospital declined from 11.7 to 8.6 days. Primary myocardial infarction rates declined 33% and 54% in men aged 54–65 and women aged 65–74 years, respectively.

Conclusions

The present study provides, for the first time in Israel, data on selected quality of care and clinical outcomes using a large, population-based registry of cardiovascular disease patients. It demonstrates a significant improvement in the adherence with LDL tests and achieving target LDL levels and a subsequent decline in incidence of myocardial infarction within ten years since its establishment.

Introduction

Despite a significant reduction in cause-specific mortality rates over the last four decades, cardiovascular diseases (CVD) still account for approximately 30% of all deaths in Israel [1]. While great advances have been made in the management of acute CVD events, a great potential for future improvement in the benefit of therapies for CVD can come in the form of primary and secondary prevention in outpatient community healthcare. Effective outpatient CVD prevention requires available information on personal risk factors through appropriate patient records, an approach that is supported by guidelines from the National Cholesterol Education Program Adult Treatment Panel III [2]. One method to obtain and collect patient information is by maintaining chronic disease registries.

Disease registry is a systematic and comprehensive approach to caring for patients with chronic diseases that is aimed at improving the quality of chronic care delivery. It supports physicians and other members of the care team in identifying and reaching out to patients with gaps in care, prompts the team to ensure a timely care, and allows the provision of summarize data on patients who are overdue for care or are not meeting management goals [3]. Disease-specific registers are being increasingly developed in Western countries such as the UK in response to national quality frameworks [4]. Earlier work suggests that disease-specific registers can provide good-quality information relating to individual patients as well as for epidemiological monitoring and service planning [5], [6], [7]. Previous studies have shown that well-administered CVD registers enable patient profiling and patterns of care to be examined within individuals or groups of general practices [8], [9].

In 1998, Maccabi Healthcare Services (MHS), a 1.8 million member health maintenance organization (HMO) in Israel, has initiated an on-going computerized registry of CVD patients to assess treatments and outcomes, to appraise the effectiveness of CVD primary and secondary prevention programs, to reduce disparities in healthcare services, and to investigate trend in the epidemiology of CVD over time. The design, methods, and general population description of the MHS cardiovascular disease registry study will be presented herein.

Section snippets

Maccabi Healthcare Services

In Israel, universal healthcare services are provided by four health maintenance organizations (HMOs) that are obligated to insure every citizen who wishes to join them, irrespective of age, sex, or medical history. Maccabi Healthcare Services (MHS) is the second largest publicly funded HMO in Israel, serving 24% of the total population with a nationwide distribution. The age distribution amongst MHS members is similar to that of the general Israeli population and the median age amongst MHS

Results

Ten years following its establishment in 1998, the number of patients identified by the MHS CVD registry has increased from 34,144 to 80,339. During this period, the age-adjusted prevalence rates of known CVD have risen from 3.7% to 5.1% and from 1.9% to 2.6% among men and women, respectively (Table 1). There were little changes in the mean age of the registry patients (~ 61 years) and proportion of men (~ 61%) across the investigated calendar years.

Two quality of care indicators are discussed

Discussion

The NHS CVD registry provides for the first time an opportunity to study population-based disease incidence and mortality rates in Israel. Analyses of age-and-gender-specific incidence rates of MI show well-documented patterns of higher risk among men than among women, and a steep increase with age for both sexes. More importantly, a clear decline in incidence of MI in MHS between 1998 and 2007 was seen. Our results also indicate a gradual decline in the average length of hospital stay among

Acknowledgement

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [23].

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