Kaiser culls own data for insight
Kaiser Permanente Hawaii is taking an unusual approach to improve care, reduce early deaths and lower costs for patients with cardiovascular disease.
Instead of recruiting volunteers for an expensive study, it is using its electronic medical record system, KP HealthConnect, to examine heart disease prevention and management in about 150,000 adult isle patients.
"What we're interested in learning is how electronic medical records improve care," Dr. Thomas M. Vogt, senior investigator at Kaiser Permanente's Center for Health Research in Honolulu and principal investigator for the two-year study, said in an interview.
The center received $600,000 from the Agency for Healthcare Research and Quality to study prevention and management of heart disease and stroke and find ways to improve cardiovascular care nationwide.
Kaiser Permanente is the largest system in the country with a comprehensive electronic medical record system, used for nearly 9 million members throughout 448 Kaiser medical centers and medical offices across the country, Vogt said.
The method of using the electronic system to improve health outcomes was developed by Kaiser Permanente under several grants and is being examined as a model by researchers, other health systems and the federal government, he said.
Using KP HealthConnect, Vogt said the researchers are able to study an entire population -- all of Kaiser's adult patients in Hawaii -- in ways that weren't possible before. They can analyze a patient's "total medical experience" through the data to find the most effective patterns of care, he said.
Dr. Greg Pawlson, executive vice president of the National Committee for Quality Assurance, said in a news release that prevention and management of cardiovascular disease present "one of the greatest opportunities in health care for improving health and reducing the burden of chronic cardiovascular diseases like congestive heart failure and ischemic vascular disease."
Vogt said guidelines for cardiovascular care "are driven by research that says, 'Those things are important and they work.'" But there is wide variation among patients and physician practices, he said.
Researchers will look at variations in the data, how they relate over time to the risk of heart disease and stroke and treatment outcomes, he said.
His guess is that about 15,000 of the 150,000 adult Kaiser patients in Hawaii are being managed for high blood pressure. Researchers can determine how aggressively physicians managed their blood pressure and how that related during five years, for example, to risk of heart disease and stroke, he said.
Many patients are identified with high blood pressure and started on treatment, he said. "But it is hit or miss. They may not be taking the right drugs or adhering to drugs or being treated with enough drugs. With records, we can characterize patients and look at outcomes years later."
KP HealthConnect can also be used to improve health care outcomes for other conditions, Vogt said, noting the Center for Health Research has a grant for a similar study on cancer and another grant is pending to look at diabetes.
Vogt stressed that confidentiality is protected under rigid requirements. "There are very explicit regulations ... that permit this kind of research precisely because we can learn things with it that we can't learn any other way."