From quality indicator to quality measurement: design and implementation of an automated audit and feedback tool for chronic kidney disease in Belgian primary care.

OBJECTIVES: To design and implement an automated audit and feedback (A&F) tool for Belgian Electronic Medical Record (EMR) systems to assess and improve the quality of primary care for chronic kidney disease (CKD). METHODS: 36 quality indicators (QIs) for primary CKD care were translated into conjugations and queries programmable within EMR systems. In the development phase, executable queries were constructed, taking into account technical constraints and the reliability of available data. The Intego database, a Belgian general practice-based morbidity registration network and A&F implementation laboratory, was used to test the feasibility and pilot the intervention. Visual feedback dashboards were designed using SAS Enterprise Guide and SAS Visual Analytics. RESULTS: A final set of 80 queries that could be built into EMR systems was developed, allowing for an automated audit. The design of visual feedback and follow-up queries to make the feedback actionable was described. During the selection process 16 of the 36 indicators were excluded and 10 were adapted for the audit and/or feedback due to technical limitations or unreliable data. The final feedback included 14 indicators presented to clinicians through interactive dashboards. DISCUSSION: This study describes the design of an automated A&F tool to improve the quality of primary CKD care in Belgium. Challenges included data accuracy within EMRs, the variability in data completeness and limitations in EMR query functionality. Future improvements in EMR systems and coding practices, such as the implementation of the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and improving feedback accessibility, could enhance the effectiveness of the tool. CONCLUSION: This study provides building blocks for implementing automated A&F interventions in Belgian EMR systems to improve primary CKD care quality. These building blocks could be applied internationally after validating the QIs.