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Chen Y, Liu X, Gao L, Zhu M, Shia BC, Chen M, Ye L, Qin L. Using the H2O Automatic Machine Learning Algorithms to Identify Predictors of Web-Based Medical Record Nonuse Among Patients in a Data-Rich Environment: Mixed Methods Study. JMIR Med Inform 2023; 11:e41576. [PMID: 37335616 DOI: 10.2196/41576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/26/2022] [Accepted: 04/08/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND With the advent of electronic storage of medical records and the internet, patients can access web-based medical records. This has facilitated doctor-patient communication and built trust between them. However, many patients avoid using web-based medical records despite their greater availability and readability. OBJECTIVE On the basis of demographic and individual behavioral characteristics, this study explores the predictors of web-based medical record nonuse among patients. METHODS Data were collected from the National Cancer Institute 2019 to 2020 Health Information National Trends Survey. First, based on the data-rich environment, the chi-square test (categorical variables) and 2-tailed t tests (continuous variables) were performed on the response variables and the variables in the questionnaire. According to the test results, the variables were initially screened, and those that passed the test were selected for subsequent analysis. Second, participants were excluded from the study if any of the initially screened variables were missing. Third, the data obtained were modeled using 5 machine learning algorithms, namely, logistic regression, automatic generalized linear model, automatic random forest, automatic deep neural network, and automatic gradient boosting machine, to identify and investigate factors affecting web-based medical record nonuse. The aforementioned automatic machine learning algorithms were based on the R interface (R Foundation for Statistical Computing) of the H2O (H2O.ai) scalable machine learning platform. Finally, 5-fold cross-validation was adopted for 80% of the data set, which was used as the training data to determine hyperparameters of 5 algorithms, and 20% of the data set was used as the test data for model comparison. RESULTS Among the 9072 respondents, 5409 (59.62%) had no experience using web-based medical records. Using the 5 algorithms, 29 variables were identified as crucial predictors of nonuse of web-based medical records. These 29 variables comprised 6 (21%) sociodemographic variables (age, BMI, race, marital status, education, and income) and 23 (79%) variables related to individual lifestyles and behavioral habits (such as electronic and internet use, individuals' health status and their level of health concern, etc). H2O's automatic machine learning methods have a high model accuracy. On the basis of the performance of the validation data set, the optimal model was the automatic random forest with the highest area under the curve in the validation set (88.52%) and the test set (82.87%). CONCLUSIONS When monitoring web-based medical record use trends, research should focus on social factors such as age, education, BMI, and marital status, as well as personal lifestyle and behavioral habits, including smoking, use of electronic devices and the internet, patients' personal health status, and their level of health concern. The use of electronic medical records can be targeted to specific patient groups, allowing more people to benefit from their usefulness.
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Affiliation(s)
- Yang Chen
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Xuejiao Liu
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Lei Gao
- School of Law, University of International Business and Economics, Beijing, China
| | - Miao Zhu
- School of Statistics, Huaqiao University, Xiamen, China
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Linglong Ye
- School of Public Affairs, Xiamen University, Xiamen, China
| | - Lei Qin
- School of Statistics, University of International Business and Economics, Beijing, China
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
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Alsulamy N, Lee A, Thokala P. Healthcare professionals' views on factors influencing shared decision-making in primary health care centres in Saudi Arabia: A qualitative study. J Eval Clin Pract 2022; 28:235-246. [PMID: 34467591 DOI: 10.1111/jep.13616] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the perspectives of healthcare professionals regarding the implementation of Shared decision-making (SDM) in primary healthcare centres (PHCCs) in Saudi Arabia. METHODS Qualitative semi-structured interviews were conducted with a purposive and snowball sample of healthcare professionals in PHCCs. Interviews have been recorded, transcribed, translated and thematically analysed. Themes were mapped to the COM-B model. RESULTS Sixteen healthcare professionals were interviewed. The data analysis identified six themes and 14 sub-themes. The six themes are patient related factors, health professional related factors, environmental context and resources, patient-physician communication, patient-physician preferences toward SDM and physicians' perceived value and benefits of SDM. Physicians are unlikely to practice SDM in the context of time pressures, shortage of physicians, lack of treatment options, and decision-making aids. The findings also underscored the importance of building a trustworthy physician-patient relationship through the use of effective conversation techniques. CONCLUSIONS There are multiple barriers to SDM in primary care. Unless these barriers are addressed, it is unlikely that physicians will effectively or fully engage in SDM with patients.
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Affiliation(s)
- Nouf Alsulamy
- Public Health, The University of Sheffield, Sheffield, UK.,College of Business, University of Jeddah, Jeddah, Saudi Arabia
| | - Andrew Lee
- Public Health, The University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
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Stahl K, Groene O. ASK ME!-Routine measurement of patient experience with patient safety in ambulatory care: A mixed-mode survey. PLoS One 2021; 16:e0259252. [PMID: 34851966 PMCID: PMC8635405 DOI: 10.1371/journal.pone.0259252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/15/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Routine measurement of patient safety from the patients’ perspective receives increasing attention as an important component of safety measurement systems. The aim of this study was to examine patients’ experience with patient safety in ambulatory care and the results’ implications for routine patient safety measurement in ambulatory care. Design Cross-sectional mixed-mode survey. Setting General practitioner and specialist practices. Participants Patients aged >18 years seeking care in ambulatory care practices between February and June 2020. Methods A 22-item-questionnaire was completed in the practice or at home either on paper or online. Multivariate logistic regression was used to analyse the influence of survey mode and patient characteristics on patient experience with patient safety. Results The overall response rate was 71.1%. Most patients completed the questionnaire on site (76.6%) and on paper (96.1%). Between 30.1% to 68.5% of the respondents report the most positive option for patient experience with the main domains of patient safety. A total of 2.9% of patients reported having experienced a patient-safety event (PSE) during the last 12 months. Patients who filled in the questionnaire off site were more likely to report negative experiences for the scales communication & information (OR 1.2, 95% CI 1.0–1.5), rapport & participation (OR 1.4, 95% CI 1.1–1.7) and access (OR 1.3, 95% CI 0.9–1.4) than those who completed it on site. Those who chose a paper questionnaire were more likely to report negative experiences for all five scales compared to web responders. Conclusion Routine measurement of patient experience with factors contributing to the occurrence of PSEs can achieve high response rates by offering flexible participation options. Results gained from mixed-mode surveys need to take mode-effects into account when interpreting and using the results. Further research is needed in how to adequately assess number and type of experienced events in routine measurements.
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Affiliation(s)
- Katja Stahl
- Department Research & Innovation, OptiMedis AG, Hamburg, Germany
- * E-mail:
| | - Oliver Groene
- Department Research & Innovation, OptiMedis AG, Hamburg, Germany
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Zweifel P. Innovation in health care through information technology (IT): The role of incentives. Soc Sci Med 2021; 289:114441. [PMID: 34592541 DOI: 10.1016/j.socscimed.2021.114441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/16/2021] [Accepted: 09/24/2021] [Indexed: 11/27/2022]
Abstract
For several years now, information technology (IT) has been hailed as an innovation that will revolutionize medicine and health care more generally. Yet adoption of new IT in the healthcare sector has been slow, possibly reflecting a lack of interest. In economic terms, the incentives of the major players in health care may work against new IT, which fosters process and organizational innovation much more than product innovation. While product innovation causes an increase in consumers' willingness to pay and is therefore welcomed by those working in the healthcare sector, process innovation is resisted because it often means performing the same service but at a lower cost. This is also true of organizational innovation, which frequently entails vertical integration and hence a loss of autonomy (as evidenced by the difficulties of creating Managed Care Organizations). The objective of this paper therefore is to predict the circumstances in which (both current and potential) patients, physicians, hospitals, health insurers, and governments are likely to support innovation in health care through IT.
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Elkefi S, Yu Z, Asan O. Online Medical Record Nonuse Among Patients: Data Analysis Study of the 2019 Health Information National Trends Survey. J Med Internet Res 2021; 23:e24767. [PMID: 33616539 PMCID: PMC7939938 DOI: 10.2196/24767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/19/2020] [Accepted: 12/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual understanding and trust. OBJECTIVE We aimed to understand the reasons why patients tend to avoid using online medical records and to compare the perceptions that patients have of online medical records based on demographics and cancer diagnosis. METHODS We used data from the Health Information National Trends Survey Cycle 3, a nationally representative survey, and assessed outcomes using descriptive statistics and chi-square tests. The patients (N=4328) included in the analysis had experienced an outpatient visit within the previous 12 months and had answered the online behavior question regarding their use of online medical records. RESULTS Patients who were nonusers of online medical records consisted of 58.36% of the sample (2526/4328). The highest nonuser rates were for patients who were Hispanic (460/683, 67.35%), patients who were non-Hispanic Black (434/653, 66.46%), and patients who were older than 65 years (968/1520, 63.6%). Patients older than 65 years were less likely to use online medical records (odds ratio [OR] 1.51, 95% CI 1.24-1.84, P<.001). Patients who were White were more likely to use online medical records than patients who were Black (OR 1.71, 95% CI 1.43-2.05, P<.001) or Hispanic (OR 1.65, 95% CI 1.37-1.98, P<.001). Patients who were diagnosed with cancer were more likely to use online medical records compared to patients with no cancer (OR 1.31, 95% CI 1.11-1.55, 95% CI 1.11-1.55, P=.001). Among nonusers, older patients (≥65 years old) preferred speaking directly to their health care providers (OR 1.76, 95% CI 1.35-2.31, P<.001), were more concerned about privacy issues caused by online medical records (OR 1.79, 95% CI 1.22-2.66, P<.001), and felt uncomfortable using the online medical record systems (OR 10.55, 95% CI 6.06-19.89, P<.001) compared to those aged 18-34 years. Patients who were Black or Hispanic were more concerned about privacy issues (OR 1.42, 1.09-1.84, P=.007). CONCLUSIONS Studies should consider social factors such as gender, race/ethnicity, and age when monitoring trends in eHealth use to ensure that eHealth use does not induce greater health status and health care disparities between people with different backgrounds and demographic characteristics.
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Affiliation(s)
- Safa Elkefi
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Zhongyuan Yu
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
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Azar KMJ, Petersen JP, Shen Z, Nasrallah C, Pesa J, LaMori J, Pressman A. Serious Mental Illness and Health-Related Factors Associated with Regional Emergency Department Utilization. Popul Health Manag 2019; 23:430-437. [PMID: 31816257 DOI: 10.1089/pop.2019.0161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Frequent emergency department (ED) utilization is an indicator of unmet health and social needs, especially among patients with mental and physical health problems. The authors aimed to characterize frequent ED utilizers and drivers of multiple ED use, including presence of serious mental illness (SMI), across 2 large health care systems in Northern California. Using electronic health records and a data-sharing platform, a cross-sectional analysis was conducted of patients aged 18+ years with ≥10 ED visits in 2016. Logistic regression was used to determine factors associated with multiple ED use versus single ED use. Among the 8036 patients who met inclusion criteria, the mean age was 55.9 years (95% CI = 55.5-56.4), 53% were female, 54% were non-Hispanic white, and 38% had any SMI. Overall, 51% of patients were single ED utilizers. Patients ages ≥65 years were less likely to use multiple EDs compared to younger patients (ages 18-23) (OR = 0.3, 95% CI = 0.2-0.4). African Americans exhibited more than 3 times the likelihood of multi-ED use compared to non-Hispanic whites (OR = 3.8, 95% CI = 3.3-4.3). A diagnosis of any SMI (OR = 2.3 [95% CI: 2.1-2.6]), major depressive disorder (OR = 1.3, 95% CI = 1.1-1.4), schizophrenia (OR = 2.1, 95% CI = 1.6-2.6), or suicidal attempts/ideation (OR = 2.7, 95% CI = 2.1-3.6) was significantly associated with increased likelihood of multi-ED use. Findings indicate heterogeneity in regional utilization patterns among frequent ED utilizers, with mental illness increasing the likelihood of multi-ED use.
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Affiliation(s)
- Kristen M J Azar
- Sutter Health, Research Development, and Dissemination, Walnut Creek, California, USA
| | - John P Petersen
- Sutter Health, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Zijun Shen
- Sutter Health, Research Development, and Dissemination, Walnut Creek, California, USA
| | | | - Jacqueline Pesa
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Joyce LaMori
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Alice Pressman
- Sutter Health, Research Development, and Dissemination, Walnut Creek, California, USA
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Sarkar U, McDonald K, Motala A, Smith P, Zipperer L, Wachter RM, Shanman R, Shekelle PG. Pragmatic Insights on Patient Safety Priorities and Intervention Strategies in Ambulatory Settings. Jt Comm J Qual Patient Saf 2019; 43:661-670. [PMID: 29173287 DOI: 10.1016/j.jcjq.2017.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 11/27/2022]
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Abstract
The aim of this study is to perform a systematic review of the costing methodological approaches adopted by published cost-of-illness (COI) studies. A systematic review was performed to identify cost-of-illness studies of heart failure published between January 2003 and September 2015 via computerized databases such as Pubmed, Wiley Online, Science Direct, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Costs reported in the original studies were converted to 2014 international dollars (Int$). Thirty five out of 4972 studies met the inclusion criteria. Nineteen out of the 35 studies reported the costs as annual cost per patient, ranging from Int$ 908.00 to Int$ 84,434.00, while nine studies reported costs as per hospitalization, ranging from Int$ 3780.00 to Int$ 34,233.00. Cost of heart failure increased as condition of heart failure worsened from New York Heart Association (NYHA) class I to NYHA class IV. Hospitalization cost was found to be the main cost driver to the total health care cost. The annual cost of heart failure ranges from Int$ 908 to Int$ 40,971 per patient. The reported cost estimates were inconsistent across the COI studies, mainly due to the variation in term of methodological approaches such as disease definition, epidemiological approach of study, study perspective, cost disaggregation, estimation of resource utilization, valuation of unit cost components, and data sources used. Such variation will affect the reliability, consistency, validity, and relevance of the cost estimates across studies.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia.
| | - Yui Ping Tan
- Discipline of Social Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Chin Hui Ng
- Discipline of Social Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
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Voruganti T, Grunfeld E, Jamieson T, Kurahashi AM, Lokuge B, Krzyzanowska MK, Mamdani M, Moineddin R, Husain A. My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer. J Med Internet Res 2017; 19:e219. [PMID: 28720558 PMCID: PMC5539387 DOI: 10.2196/jmir.7421] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. OBJECTIVE The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. METHODS We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ≥3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. RESULTS Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. CONCLUSIONS The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. TRIAL REGISTRATION ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb).
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Affiliation(s)
- Teja Voruganti
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eva Grunfeld
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
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Kooij L, Groen WG, van Harten WH. The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review. J Med Internet Res 2017. [PMID: 28642218 PMCID: PMC5500776 DOI: 10.2196/jmir.7405] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In patients with chronic disease, many health care professionals are involved during treatment and follow-up. This leads to fragmentation that in turn may lead to suboptimal care. Shared care is a means to improve the integration of care delivered by various providers, specifically primary care physicians (PCPs) and specialty care professionals, for patients with chronic disease. The use of information technology (IT) in this field seems promising. Objective Our aim was to systematically review the literature regarding the effectiveness of IT-supported shared care interventions in chronic disease in terms of provider or professional, process, health or clinical and financial outcomes. Additionally, our aim was to provide an inventory of the IT applications' characteristics that support such interventions. Methods PubMed, Scopus, and EMBASE were searched from 2006 to 2015 to identify relevant studies using search terms related to shared care, chronic disease, and IT. Eligible studies were in the English language, and the randomized controlled trials (RCTs), controlled trials, or single group pre-post studies used reported on the effects of IT-supported shared care in patients with chronic disease and cancer. The interventions had to involve providers from both primary and specialty health care. Intervention and IT characteristics and effectiveness—in terms of provider or professional (proximal), process (intermediate), health or clinical and financial (distal) outcomes—were extracted. Risk of bias of (cluster) RCTs was assessed using the Cochrane tool. Results The initial search yielded 4167 results. Thirteen publications were used, including 11 (cluster) RCTs, a controlled trial, and a pre-post feasibility study. Four main categories of IT applications were identified: (1) electronic decision support tools, (2) electronic platform with a call-center, (3) electronic health records, and (4) electronic communication applications. Positive effects were found for decision support-based interventions on financial and health outcomes, such as physical activity. Electronic health record use improved PCP visits and reduced rehospitalization. Electronic platform use resulted in fewer readmissions and better clinical outcomes—for example, in terms of body mass index (BMI) and dyspnea. The use of electronic communication applications using text-based information transfer between professionals had a positive effect on the number of PCPs contacting hospitals, PCPs’ satisfaction, and confidence. Conclusions IT-supported shared care can improve proximal outcomes, such as confidence and satisfaction of PCPs, especially in using electronic communication applications. Positive effects on intermediate and distal outcomes were also reported but were mixed. Surprisingly, few studies were found that substantiated these anticipated benefits. Studies showed a large heterogeneity in the included populations, outcome measures, and IT applications used. Therefore, a firm conclusion cannot be drawn. As IT applications are developed and implemented rapidly, evidence is needed to test the specific added value of IT in shared care interventions. This is expected to require innovative research methods.
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Affiliation(s)
- Laura Kooij
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands
| | - Wim G Groen
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands
| | - Wim H van Harten
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands.,University of Twente, Department of Health Technology and Services Research, Enschede, Netherlands.,Rijnstate hospital, Arnhem, Netherlands
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Trachtenbarg DE, Asche C, Ramsahai S, Duling J, Ren J. The benefits, risks and costs of privacy: patient preferences and willingness to pay. Curr Med Res Opin 2017; 33:845-851. [PMID: 28166481 DOI: 10.1080/03007995.2017.1292229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Multiple surveys show that patients want medical privacy; however, there are costs to maintaining privacy. There are also risks if information is not shared. A review of previous surveys found that most surveys asked questions about patient's privacy concerns and willingness to share their medical information. We found only one study that asked about sharing medical information for better care and no survey that asked patients about the risk, cost or comparison between medical privacy and privacy in other areas. To fill this gap, we designed a survey to: (1) compare medical privacy preferences to privacy preferences in other areas; (2) measure willingness to pay the cost of additional privacy measures; and (3) measure willingness to accept the risks of not sharing information. METHODS A total of 834 patients attending physician offices at 14 sites completed all or part of an anonymous questionnaire. RESULTS Over 95% of patients were willing to share all their medical information with their treating physicians. There was no difference in willingness to share between primary care and specialty sites including psychiatry and an HIV clinic. In our survey, there was no difference in sharing preference between standard medical information and information with additional legal protections including genetic testing, drug/alcohol treatment and HIV results. Medical privacy was ranked lower than sharing social security and credit card numbers, but was deemed more private than other information including tax returns and handgun purchases. There was no statistical difference for any questions by site except for HIV/AIDS clinic patients ranking privacy of the medical record more important than reducing high medical costs and risk of medical errors (p < .05). Most patients were willing to spend a modest amount of additional time for privacy, but few were willing to pay more for additional medical privacy. Most patients were unwilling to take on additional risks to keep medical information hidden. CONCLUSIONS Patients were very willing to share medical information with their providers. They were able to see the importance of sharing medical information to provide the best possible care. They were unwilling to hide information from providers if there was increased medical risk. Patients were willing to spend additional time for privacy, but most were unwilling to spend extra money. Sixty-eight percent of patients favored reducing medical costs over privacy.
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Affiliation(s)
- David E Trachtenbarg
- a The University of Illinois College of Medicine Peoria , IL , USA
- b Central Illinois Health Information Exchange , IL , USA
- c UnityPoint Health , Peoria , IL , USA
| | - Carl Asche
- a The University of Illinois College of Medicine Peoria , IL , USA
| | - Shweta Ramsahai
- a The University of Illinois College of Medicine Peoria , IL , USA
- d OSF Healthcare , Peoria , IL , USA
| | - Joy Duling
- b Central Illinois Health Information Exchange , IL , USA
| | - Jinma Ren
- a The University of Illinois College of Medicine Peoria , IL , USA
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Brener SS, Bronksill SE, Comrie R, Huang A, Bell CM. Association between in-hospital supportive visits by primary care physicians and patient outcomes: A population-based cohort study. J Hosp Med 2016; 11:418-24. [PMID: 26914153 DOI: 10.1002/jhm.2561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND One long-standing method for continuity of care as patients transition between the hospital and community are supportive visits by primary care physicians during hospitalization. METHODS This retrospective cohort study used administrative data of adults hospitalized from 2008 to 2009 and primary care physicians who conduct supportive visits. Patients who received a visit from their primary care physician while hospitalized were compared to those who did not. Composite outcomes of death, emergency department visit, or emergent readmission within 30 and 90 days were assessed. Postdischarge home-care utilization and primary care physician visits were also examined. Multivariate logistic regression models adjusted for age, sex, low income, rurality, and readmission risk. RESULTS Of the 164,059 patients linked to 3236 primary care physicians, 12.0% received visits while hospitalized. Visited patients had more readmissions, more deaths, and fewer emergency department visits than patients who did not. However, after adjusting, visited patients had a lower risk for the composite outcome at 30 days (adjusted OR [aOR]: 0.92; 95% confidence interval [CI]: 0.89-0.96) and 90 days (aOR: 0.90; 95% CI: 0.87-0.92). Visited patients were also more likely to access community primary care-provider visits and more home-care services. The in-hospital visit resulted in an increased likelihood of health services utilization at 30 days (aOR: 1.16; 95% CI: 1.11-1.22) and 90 days (aOR: 1.20; 95% CI: 1.12-1.27). CONCLUSION A hospital supportive-care visit from a primary care physician resulted in lower risks of adverse patient outcomes and increased access to community health services. Journal of Hospital Medicine 2016;11:418-424. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Stacey S Brener
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
| | - Susan E Bronksill
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | | | - Anjie Huang
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
| | - Chaim M Bell
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Medicine, University of Toronto and Mount Sinai Hospital, Toronto, Canada
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Rinner C, Sauter SK, Endel G, Heinze G, Thurner S, Klimek P, Duftschmid G. Improving the informational continuity of care in diabetes mellitus treatment with a nationwide Shared EHR system: Estimates from Austrian claims data. Int J Med Inform 2016; 92:44-53. [PMID: 27318070 DOI: 10.1016/j.ijmedinf.2016.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Shared Electronic Health Record (EHR) systems, which provide a health information exchange (HIE) within a community of care, were found to be a key enabler of informational continuity of diabetes mellitus (DM) care. Quantitative analyses of the actual contribution of Shared EHR systems to informational continuity of care are rare. The goal of this study was to quantitatively analyze (i) the degree of fragmentation of DM care in Austria as an indicator for the need for HIE, and (ii) the quantity of information (i.e. number of documents) from Austrian DM patients that would be made available by a nationwide Shared EHR system for HIE. METHODS Our analyses are based on social security claims data of 7.9 million Austrians from 2006 and 2007. DM patients were identified through medication data and inpatient diagnoses. The degree of fragmentation was determined by the number of different healthcare providers per patient. The amount of information that would be made available by a nationwide Shared EHR system was estimated by the number of documents that would have been available to a healthcare provider if he had access to information on the patient's visits to any of the other healthcare providers. As a reference value we determined the number of locally available documents that would have originated from the patient's visits to the healthcare provider himself. We performed our analysis for two types of systems: (i) a "comprehensive" Shared EHR system (SEHRS), where each visit of a patient results in a single document (progress note), and (ii) the Austrian ELGA system, which allows four specific document types to be shared. RESULTS 391,630 DM patients were identified, corresponding to 4.7% of the Austrian population. More than 90% of the patients received health services from more than one healthcare provider in one year. Both, the SEHRS as well as ELGA would have multiplied the available information during a patient visit in comparison to an isolated local EHR system; the median ratio of external to local medical documents was between 1:1 for a typical visit at a primary care provider (SEHRS as well as ELGA) and 39:1 (SEHRS) respectively 28:1 (ELGA) for a typical visit at a hospital. CONCLUSIONS Due to the high degree of care fragmentation, there is an obvious need for HIE for Austrian DM patients. Both, the SEHRS as well as ELGA could provide a substantial contribution to informational continuity of care in Austrian DM treatment. Hospitals and specialists would have gained the most amount of external information, primary care providers and pharmacies would have at least doubled their available information. Despite being the most important potential feeders of a national Shared EHR system according to our analysis, primary care providers will not tap their full corresponding potential under the current implementation scenario of ELGA.
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Affiliation(s)
- Christoph Rinner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Simone Katja Sauter
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Gottfried Endel
- Main Association of Austrian Social Security Institutions, Kundmanngasse 21, A-1031 Vienna, Austria
| | - Georg Heinze
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Stefan Thurner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria; Santa Fe Institute, Santa Fe, NM 87501, USA; International Institute for Applied Systems Analysis, A-2361 Laxenburg, Austria
| | - Peter Klimek
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Georg Duftschmid
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria.
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Doyle MA, Malcolm JC, Liu D, Maranger J, Ooi TC, Keely E. Using a Structured Discharge Letter Template to Improve Communication During the Transition from a Specialized Outpatient Diabetes Clinic to a Primary Care Physician. Can J Diabetes 2015; 39:457-66. [DOI: 10.1016/j.jcjd.2015.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 10/22/2022]
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Uppal NK, Eisen D, Weissberger J, Wyman RJ, Urbach DR, Bell CM. Transfer of care of postsurgical patients from hospital to the community setting: cross-sectional survey of primary care physicians. Am J Surg 2015; 210:778-82. [DOI: 10.1016/j.amjsurg.2015.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/29/2015] [Accepted: 03/03/2015] [Indexed: 11/16/2022]
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Wiggins C, Peterson T, Moss C. Ambulatory surgery centers׳ use of Health Information Technology. HEALTH POLICY AND TECHNOLOGY 2015. [DOI: 10.1016/j.hlpt.2015.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kalankesh LR, Farahbakhsh M, Rahimi N. Data Content and Exchange in General Practice: a Review. Med Arch 2014; 68:414-418. [PMID: 25648317 PMCID: PMC4314165 DOI: 10.5455/medarh.2014.68.414-418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/01/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND efficient communication of data is inevitable requirement for general practice. Any issue in data content and its exchange among GP and other related entities hinders continuity of patient care. METHODS literature search for this review was conducted on three electronic databases including Medline, Scopus and Science Direct. RESULTS through reviewing papers, we extracted information on the GP data content, use cases of GP information exchange, its participants, tools and methods, incentives and barriers. CONCLUSION considering importance of data content and exchange for GP systems, it seems that more research is needed to be conducted toward providing a comprehensive framework for data content and exchange in GP systems.
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Affiliation(s)
- Leila R Kalankesh
- School of Management and Medical Informatics, Tabriz University of Medical Sciences
- School of Management and Medical Informatics, Tabriz Health Services Management Research Center
| | | | - Niloofar Rahimi
- School of Management and Medical Informatics, Tabriz University of Medical Sciences
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A two-site survey of clinicians to identify practices and preferences of intensive care unit transfers to general medical wards. J Crit Care 2014; 30:358-62. [PMID: 25499415 DOI: 10.1016/j.jcrc.2014.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/22/2014] [Accepted: 10/26/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The transfer of patients from the intensive care unit (ICU) to the general medical ward is high risk for adverse events and health care provider dissatisfaction. We aimed to identify perceived practices, and what information is important to communicate during an ICU transfer. METHODS This study used a self-administered questionnaire that surveyed physicians in 2 different hospitals. These physicians provide care in either the ICU or the general medical ward. Responses were evaluated with Likert scales and frequencies. RESULTS A total of 121 physicians (54% response rate) completed the survey. Current practice most often includes written chart and telephone communication. Most providers (63.3%) believed that the current process is inadequate. Surprises are common (79% of respondents); and reported adverse events include medication errors (60.4%), aspiration (49.5%), and decreased level of consciousness requiring intervention (44.6%). The use of an ICU transfer tool is one potential mechanism of improving this process of care, and providers reported several items that may be useful. CONCLUSION Providers reported the current process of transferring patients from the ICU to the general medical ward as inadequate. We highlight data that physicians feel is important to communicate at the time of transfer.
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Doos L, Bradley E, Rushton CA, Satchithananda D, Davies SJ, Kadam UT. Heart failure and chronic obstructive pulmonary disease multimorbidity at hospital discharge transition: a study of patient and carer experience. Health Expect 2014; 18:2401-12. [PMID: 24831061 DOI: 10.1111/hex.12208] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Care for patients with multimorbidity represents a major challenge not only for patients and carers but to health-care systems. Hospital discharge transition is a critical point at which challenges for multimorbidity may amplify. OBJECTIVES The main objective of the study was to explore the experiences of heart failure (HF) and chronic obstructive pulmonary disease (COPD) multimorbid patients and their carers on hospital discharge. Secondary objectives included identification of gaps in the health care of multimorbidity and optimal solutions from patients and carers' perspectives. DESIGN Mixed methods were applied to collect data using patient self-completion questionnaire from an adapted version of the American Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and in-depth interviews. SETTING Participants were recruited from two cardiology and respiratory wards at a large regional hospital in England, and all had a multimorbidity diagnosis of COPD and HF. RESULTS AND CONCLUSIONS Findings revealed that patients experienced difficulties in their communication with health-care professionals and there were specific challenges with information about medication. Qualitative descriptions revealed that experiences fell into two main categories: (i) information transfer to patients with multimorbidity in terms of issues with medication and clarity of information on diagnosis and (ii) communication and continuity of care after discharge. Respondents highlighted gaps in the management of patients with multimorbidity of HF and COPD at the critical time of care transition. They suggested the need for a comprehensive, coordinated and integrated approach to incorporate patients, carers and staff preferences for treatment on discharge from hospital.
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Affiliation(s)
- Lucy Doos
- NIHR Horizon Scanning Centre, Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Eleanor Bradley
- Institute of Health and Society, Worcester University, Worcester, UK
| | - Claire A Rushton
- Health Service Research Unit, Keele University, Staffordshire, UK
| | | | - Simon J Davies
- Health Service Research Unit, Keele University, Staffordshire, UK
| | - Umesh T Kadam
- Health Service Research Unit, Keele University, Staffordshire, UK
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McMurray J, Hicks E, Johnson H, Elliott J, Byrne K, Stolee P. 'Trying to find information is like hating yourself every day': the collision of electronic information systems in transition with patients in transition. Health Informatics J 2014; 19:218-32. [PMID: 23981396 DOI: 10.1177/1460458212467547] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers' ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care's 'culture of documentation'. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers' burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures.
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Affiliation(s)
- Josephine McMurray
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue, Waterloo, ON N2L3G1, Canada.
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El Kassem W, Abdulrahman A, Raghab A, Wilbur K, Elgaily DE, Sahal AO, Orabi BA, Ibrahim DA, Wilby KJ. Should clinical practitioners, as part of institutional or accreditation standards, be required to document their rationale when choosing to not adhere to widely accepted clinical practice guidelines? Can J Hosp Pharm 2013; 66:253-5. [PMID: 23950610 DOI: 10.4212/cjhp.v66i4.1272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Zed PJ, Haughn C, Black KJL, Fitzpatrick EA, Ackroyd-Stolarz S, Murphy NG, MacKinnon NJ, Curran JA, Sinclair D. Medication-related emergency department visits and hospital admissions in pediatric patients: a qualitative systematic review. J Pediatr 2013; 163:477-83. [PMID: 23465404 DOI: 10.1016/j.jpeds.2013.01.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/27/2012] [Accepted: 01/22/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To review and describe the current literature pertaining to the incidence, classification, severity, preventability, and impact of medication-related emergency department (ED) and hospital admissions in pediatric patients. STUDY DESIGN A systematic search of PubMED, Embase, and Web of Science was performed using the following terms: drug toxicity, adverse drug event, medication error, emergency department, ambulatory care, and outpatient clinic. Additional articles were identified by a manual search of cited references. English language, full-reports of pediatric (≤18 years) patients that required an ED visit or hospital admission secondary to an adverse drug event (ADE) were included. RESULTS We included 11 studies that reported medication-related ED visit or hospital admission in pediatric patients. Incidence of medication-related ED visits and hospital admissions ranged from 0.5%-3.3% and 0.16%-4.3%, respectively, of which 20.3%-66.7% were deemed preventable. Among ED visits, 5.1%-22.1% of patients were admitted to hospital, with a length of stay of 24-72 hours. The majority of ADEs were deemed moderate in severity. Types of ADEs included adverse drug reactions, allergic reactions, overdose, medication use with no indication, wrong drug prescribed, and patient not receiving a drug for an indication. Common causative agents included respiratory drugs, antimicrobials, central nervous system drugs, analgesics, hormones, cardiovascular drugs, and vaccines. CONCLUSION Medication-related ED visits and hospital admissions are common in pediatric patients, many of which are preventable. These ADEs result in significant healthcare utilization.
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Affiliation(s)
- Peter J Zed
- Faculty of Pharmaceutical Sciences, Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
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Bar-Zeev SJ, Barclay L, Farrington C, Kildea S. From hospital to home: The quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia. Midwifery 2012; 28:366-73. [DOI: 10.1016/j.midw.2011.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 03/30/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
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Johnson KB, Unertl KM, Chen Q, Lorenzi NM, Nian H, Bailey J, Frisse M. Health information exchange usage in emergency departments and clinics: the who, what, and why. J Am Med Inform Assoc 2012; 18:690-7. [PMID: 21846788 DOI: 10.1136/amiajnl-2011-000308] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Health information exchange (HIE) systems are being developed across the nation. Understanding approaches taken by existing successful exchanges can help new exchange efforts determine goals and plan implementations. The goal of this study was to explore characteristics of use and users of a successful regional HIE. DESIGN We used a mixed-method analysis, consisting of cross-sectional audit log data, semi-structured interviews, and direct observation in a sample of emergency departments and ambulatory safety net clinics actively using HIE. For each site, we measured overall usage trends, user logon statistics, and data types accessed by users. We also assessed reasons for use and outcomes of use. RESULTS Overall, users accessed HIE for 6.8% of all encounters, with higher rates of access for repeat visits, for patients with comorbidities, for patients known to have data in the exchange, and at sites providing HIE access to both nurses and physicians. Discharge summaries and test reports were the most frequently accessed data in the exchange. Providers consistently noted retrieving additional history, preventing repeat tests, comparing new results to retrieved results, and avoiding hospitalizations as a consequence of HIE access. CONCLUSION HIE use in emergency departments and ambulatory clinics was focused on patients where missing information was believed to be present in the exchange and was related to factors including the roles of people with access, the setting, and other site-specific issues that impacted the overall breadth of routine system use. These data should form an important foundation as other sites embark upon HIE implementation.
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Affiliation(s)
- Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
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Mackenzie C, Syed J, Pollak PT, Koren G. Falling between the cracks: a case of amiodarone toxicity. CMAJ 2011; 183:1393-7. [PMID: 21746823 DOI: 10.1503/cmaj.100351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Constanze Mackenzie
- Department of Clinical Pharmacology and Respirology, University of Western Ontario, London, Ont.
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Vaidya SR, Shapiro JS, Lovett PB, Kuperman GJ. Acute coronary syndrome cohort definition: troponin versus ICD-9-CM codes. Future Cardiol 2011; 6:725-31. [PMID: 20932117 DOI: 10.2217/fca.10.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To determine the accuracy of troponin laboratory results versus International Classification of Diseases clinical modification codes (ICD-9-CM) in identifying acute coronary syndrome (ACS) rule-out (R/O) patients who present to emergency departments (EDs). MATERIALS & METHODS Retrospective data analysis and chart review (to establish gold standard) were conducted on ED patients. Data retrieved from a clinical data warehouse were reviewed to identify patients with two or more troponins within 24 h of ED registration and ICD-9-CM codes consistent with ACS R/O. RESULTS Of 329 charts reviewed, 17 were determined to be ACS R/O. A total of 31 out of 329 (9.42%, 95% CI: 6.26–12.58%) had two or more troponins with a sensitivity of 100% (95% CI: 77.08–100%) and specificity of 95.51% (95% CI: 92.42–97.43%). A total of 32 out of 329 patients (9.73%, 95% CI: 6.53–12.93%) had R/O ICD-9-CM codes with a sensitivity of 76.47% (95% CI: 49.76–83.00%) and specificity of 93.91% (95% CI: 90.50–96.19%). All 17 gold-standard ACS R/O patients were identified using troponins while ICD-9-CM identified 13 out of 17. CONCLUSION Clinical data (two troponins) availability is timelier and compares well with billing data (ICD-9-CM codes) in ACS R/O patient identification. Clinical data use may be generalized to identify other disease specific cohorts for clinical research.
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Affiliation(s)
- Sandip R Vaidya
- Columbia University Medical Center, 622 West 168th Street, NY 10032, USA
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Vreeman DJ, McDonald CJ, Huff SM. LOINC® - A Universal Catalog of Individual Clinical Observations and Uniform Representation of Enumerated Collections. INTERNATIONAL JOURNAL OF FUNCTIONAL INFORMATICS AND PERSONALISED MEDICINE 2011; 3:273-291. [PMID: 22899966 PMCID: PMC3418707 DOI: 10.1504/ijfipm.2010.040211] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In many areas of practice and research, clinical observations are recorded on data collection forms by asking and answering questions, yet without being represented in accepted terminology standards these results cannot be easily shared among clinical care and research systems. LOINC contains a well-developed model for representing variables, answer lists, and the collections that contain them. We have successfully added many assessments and other collections of variables to LOINC in this model. By creating a uniform representation and distributing it worldwide at no cost, LOINC aims to lower the barriers to interoperability among systems and make this valuable data available across settings when and where it is needed.
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Affiliation(s)
- Daniel J. Vreeman
- Assistant Research Professor and Research Scientist, Indiana University School of Medicine and Regenstrief Institute, 410 W. 10Street, Suite 2000, Indianapolis, IN 46202
| | - Clement J. McDonald
- Director of Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bldg. 38-A, Rm. 7N704, Bethesda, MD 20894
| | - Stanley M. Huff
- Professor and Chief Medical Informatics Officer, University of Utah and Intermountain Healthcare, 4646 W. Lake Park Blvd., Salt Lake City, UT 84120
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Rudin RS, Salzberg CA, Szolovits P, Volk LA, Simon SR, Bates DW. Care transitions as opportunities for clinicians to use data exchange services: how often do they occur? J Am Med Inform Assoc 2011; 18:853-8. [PMID: 21531703 DOI: 10.1136/amiajnl-2010-000072] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The electronic exchange of health information among healthcare providers has the potential to produce enormous clinical benefits and financial savings, although realizing that potential will be challenging. The American Recovery and Reinvestment Act of 2009 will reward providers for 'meaningful use' of electronic health records, including participation in clinical data exchange, but the best ways to do so remain uncertain. METHODS We analyzed patient visits in one community in which a high proportion of providers were using an electronic health record and participating in data exchange. Using claims data from one large private payer for individuals under age 65 years, we computed the number of visits to a provider which involved transitions in care from other providers as a percentage of total visits. We calculated this 'transition percentage' for individual providers and medical groups. RESULTS On average, excluding radiology and pathology, approximately 51% of visits involved care transitions between individual providers in the community and 36%-41% involved transitions between medical groups. There was substantial variation in transition percentage across medical specialties, within specialties and across medical groups. Specialists tended to have higher transition percentages and smaller ranges within specialty than primary care physicians, who ranged from 32% to 95% (including transitions involving radiology and pathology). The transition percentages of pediatric practices were similar to those of adult primary care, except that many transitions occurred among pediatric physicians within a single medical group. CONCLUSIONS Care transition patterns differed substantially by type of practice and should be considered in designing incentives to foster providers' meaningful use of health data exchange services.
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Affiliation(s)
- Robert S Rudin
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
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Lewis CM, Hessel AC, Roberts DB, Guo YZ, Holsinger FC, Ginsberg LE, El-Naggar AK, Weber RS. Prereferral head and neck cancer treatment: compliance with national comprehensive cancer network treatment guidelines. ACTA ACUST UNITED AC 2011; 136:1205-11. [PMID: 21173369 DOI: 10.1001/archoto.2010.206] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE to evaluate the prereferral treatment of patients referred to our tertiary care center with recurrent or persistent head and neck cancer for compliance with National Comprehensive Cancer Network (NCCN) guidelines. DESIGN a prospective recruitment and retrospective chart review. PATIENTS the study included new patients identified at multidisciplinary treatment planning conference from October 1, 2008, to February 1, 2009, who had received prior treatment at an outside institution and presented to our department with recurrent or persistent disease. MAIN OUTCOME MEASURES all facets of prior care were examined, including the time from initial symptoms to diagnosis and whether their prereferral treatment was compliant with or deviated from NCCN guidelines for head and neck cancer. RESULTS a total of 566 consecutive new patients were identified, of whom 107 (18.9%) had persistent or recurrent disease. The average time from first presentation with initial symptoms to diagnosis among patients who presented with persistent disease was 23.8 weeks. Nearly half of the patients who presented with persistent or recurrent disease had either endocrine (21.5%) or cutaneous (24.2%) primary cancers, with the rest of the cases being distributed among 10 other sites. Of the patients who presented with recurrent or persistent disease, 43.0% had prereferral care that was noncompliant with NCCN guidelines. Of these patients, 58.7% had inadequate surgical management, 15.2% were treated for the wrong diagnosis, 10.9% received inadequate adjuvant therapy, 4.4% received inadequate radiotherapy, and 10.9% refused indicated recommended treatment. CONCLUSIONS significant deviation from NCCN guidelines for head and neck cancer treatment was observed in the cohort of study patients. The failure to administer adjuvant therapy when indicated by NCCN guidelines is particularly concerning. Economic and noneconomic costs, including lost wages, cost of "do-over" therapy, and potentially diminished survival, are substantial. Measures to ensure that patients receive therapy according to guidelines should be a national priority.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA
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Rudin R, Volk L, Simon S, Bates D. What Affects Clinicians' Usage of Health Information Exchange? Appl Clin Inform 2011; 2:250-262. [PMID: 22180762 PMCID: PMC3237190 DOI: 10.4338/aci-2011-03-ra-0021] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 04/17/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: The ability to electronically exchange health information among healthcare providers holds enormous promise to improve care coordination and reduce costs. Provider-to-provider data exchange is an explicit goal of the American Recovery and Reinvestment Act of 2009 and may be essential for the long-term success of the Affordable Care Act of 2010. However, little is known about what factors affect clinicians' usage of health information exchange (HIE) functionality. OBJECTIVE: To identify factors that affect clinicians' HIE usage - in terms of frequency of contributing data to and accessing data from aggregate patient records - and suggest policies for fostering its usage. METHODS: We performed a qualitative study using grounded theory by interviewing clinician-users and HIE staff of one operational HIE which supported aggregate patient record functionality. Fifteen clinicians were interviewed for one hour each about what factors affect their HIE usage. Five HIE staff were asked about technology and training issues to provide context. Interviews were recorded, transcribed and analyzed. Recruitment excluded clinicians with little or no familiarity with the HIE and was restricted to one community and a small number of specialties. RESULTS: Clinicians were motivated to access the HIE by perceived improvements in care quality and time savings, but their motivation was moderated by an extensive list of factors including gaps in data, workflow issues and usability issues. HIE access intensities varied widely by clinician. Data contribution intensities to the HIE also varied widely and were affected by billing concerns and time constraints. CONCLUSIONS: Clinicians, EHR and HIE product vendors and trainers should work toward integrating HIE into clinical workflows. Policies should create incentives for HIE organizations to assist clinicians in using HIE, develop measures of HIE contributions and accesses, and create incentives for clinicians to contribute data to HIEs.
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Affiliation(s)
| | - L. Volk
- Partners Healthcare, Boston, USA
| | - S. Simon
- Partners Healthcare, Boston, USA
| | - D. Bates
- Harvard Medical School, Boston, USA
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Quach S, Blais C, Quan H. Administrative data have high variation in validity for recording heart failure. Can J Cardiol 2010; 26:306-12. [PMID: 20931099 DOI: 10.1016/s0828-282x(10)70438-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Many studies have relied on administrative data to identify patients with heart failure (HF). OBJECTIVE To systematically review studies that assessed the validity of administrative data for recording HF. METHODS English peer-reviewed articles (1990 to 2008) validating International Classification of Diseases (ICD)-8, -9 and -10 codes from administrative data were included. An expert panel determined which ICD codes should be included to define HF. Frequencies of ICD codes for HF were calculated using up to the 16 diagnostic coding fields available in the Canadian hospital discharge abstract during fiscal years 2000⁄2001 and 2005⁄2006. RESULTS Between 1992 and 2008, more than 70 different ICD codes for defining HF were used in 25 published studies. Twenty-one studies validated hospital discharge abstract data; three studies validated physician claims and two studies validated ambulatory care data. Eighteen studies reported sensitivity (range 29% to 89%). Specificity and negative predictive value were greater than 70% across 17 studies. Nineteen studies reported positive predictive values (range 12% to 100%). Ten studies reported kappa values (range 0.39 to 0.84). For Canadian hospital discharge data, ICD-9 and -10 codes 428 and I50 identified HF in 5.50% and 4.80% of discharge records, respectively. Additional HF-related ICD-9 and -10 codes did not impact HF prevalence. CONCLUSION The ICD-9 and -10 codes 428 and I50 were the most commonly used to define HF in hospital discharge data. Validity of administrative data in recording HF varied across the studies and data sources that were assessed.
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Affiliation(s)
- Susan Quach
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
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van Walraven C, Taljaard M, Bell CM, Etchells E, Stiell IG, Zarnke K, Forster AJ. A prospective cohort study found that provider and information continuity was low after patient discharge from hospital. J Clin Epidemiol 2010; 63:1000-10. [PMID: 20656194 DOI: 10.1016/j.jclinepi.2010.01.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/25/2009] [Accepted: 01/25/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Continuity of care is composed of provider and information continuity and can change value over time. Most studies that have quantitatively associated continuity of care and outcomes have ignored these characteristics. This study is a detailed examination of continuity of care in patients discharged from hospital that simultaneously measured separate components of continuity over time or determined the factors with which they are associated. DESIGN SETTING Multicenter, prospective cohort study of patients discharged to the community after elective or emergent hospitalization. For all physician visits during 6 months after discharge, we identified the physician and the availability of particular information (including hospital discharge summary and any information from previous physician visits). Four physician continuity scores (preadmission; hospital admitting; hospital consultant; and postdischarge) and two information continuity scores (discharge summary and postdischarge visit information) were calculated for all patients (range: 0-1, where 0 is perfect discontinuity and 1 is perfect continuity). RESULTS Four thousand five hundred fifty-three people were followed for a median of 175 days. Both provider (range of median values: 0-0.410) and information (range: 0.220-0.427) continuity scores were low and varied extensively over time. With a few exceptions, continuity measures were independent of each other. The influence of patient factors on continuity varied extensively between the continuity measures with the most influential factors being admission urgency, admitting service, and the number of physicians who regularly treated the patient. CONCLUSION Both provider and information continuity was low in patients discharged from hospital. Continuity measures can change extensively over time, which are usually independent of each other, and are associated with patient and admission characteristics. Future studies should measure multiple components of provider and information continuity over time to completely capture continuity of care.
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van Walraven C, Taljaard M, Etchells E, Bell CM, Stiell IG, Zarnke K, Forster AJ. The independent association of provider and information continuity on outcomes after hospital discharge: implications for hospitalists. J Hosp Med 2010; 5:398-405. [PMID: 20845438 DOI: 10.1002/jhm.716] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since hospitalist physicians do not frequently see patients in follow-up after discharge from the hospital, patient continuity of care will decrease. To determine how this influenced patient outcomes, we examined the independent association of several physician continuity and information continuity measures on death or urgent readmission after discharge from hospital. DESIGN Multicenter, prospective cohort study of patients discharged to the community after elective or emergency hospitalization. We measured three physician continuity scores (preadmission; hospital; and postdischarge) and two information continuity scores (discharge summary; postdischarge visit information) as time-dependent covariates. Continuity scores ranged from 0 (perfect discontinuity) to 1 (perfect continuity). The primary outcomes were time to all-cause death or urgent readmission. RESULTS A total of 3876 people were followed for a median of 175 days. Death rate was 2.6 events per 100 patient-years observation (pys) (95% confidence interval [CI], 2.0-3.4) and urgent readmission rate was 19.6 events per 100 pys (95% CI, 15.9-24.3). After adjusting for important covariates and other continuity scores, increased preadmission physician continuity was independently associated with a decreased risk of urgent readmission (adjusted hazard ratio 0.94 [95% CI, 0.91-0.98] for each absolute increase in continuity of 0.1). Other continuity measures-including hospital physician continuity-were not associated with either outcome. CONCLUSIONS After discharge from the hospital, increased continuity with physicians who routinely treated the patient prior to the admission was significantly and independently associated with a decreased risk of urgent readmission. These data suggest that continuity with the hospital physician after discharge did not independently influence the risk of patient death or urgent readmission.
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You JJ, Laupacis A, Newman A, Bell CM. Non-adherence to recommendations for further testing after outpatient CT and MRI. Am J Med 2010; 123:557.e1-8. [PMID: 20569765 DOI: 10.1016/j.amjmed.2009.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 11/15/2009] [Accepted: 11/16/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nearly 1 in every 5 outpatient visits ends with a request for a diagnostic imaging test, and imaging reports often contain recommendations for further testing. Little is known about adherence to recommendations for further testing after outpatient computed tomography (CT) and magnetic resonance imaging (MRI). METHODS We performed a retrospective cohort study linking provincial administrative data to a cross-sectional audit of 23,691 outpatient CT and MRI scans performed in 2005 in Ontario, Canada. After excluding patients who died (n=1031), were hospitalized (n=3030), or visited an emergency department (n=3660) within 180 days of the index CT/MRI scan, 15,970 CT/MRI scans were included. The primary outcome was adherence to recommendations for further testing within 180 days of an index CT/MRI scan. RESULTS Further testing was recommended in 2027 of 15,970 (12.7%) index CT/MRI scan reports and was recommended most frequently after CT chest scans (593 of 2276 [26.1%]). From the 2027 scans in which further testing was recommended, we identified 2102 individual recommendations for a specific type of follow-up test and found that just over one third (37.6%) of these recommendations were followed at 180 days. Adherence was lower (32.3%) when patients had a visit to the referring physician within 180 days of the index CT/MRI scan, compared with when they had no such visit (50.5%; P <.001). CONCLUSIONS Radiologists commonly recommend further testing after outpatient CT and MRI scanning. However, nearly two thirds of these recommendations are not followed. This suggests that substantial opportunities exist to improve the exchange of information between clinicians and radiologists and to advance the quality of outpatient care.
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Affiliation(s)
- John J You
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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Stewart BA, Fernandes S, Rodriguez-Huertas E, Landzberg M. A preliminary look at duplicate testing associated with lack of electronic health record interoperability for transferred patients. J Am Med Inform Assoc 2010; 17:341-4. [PMID: 20442154 PMCID: PMC2995707 DOI: 10.1136/jamia.2009.001750] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 03/02/2010] [Indexed: 11/04/2022] Open
Abstract
Duplication of medical testing results in a financial burden to the healthcare system. Authors undertook a retrospective review of duplicate testing on patients receiving coordinated care across two institutions, each with its own electronic medical record system. In order to determine whether duplicate testing occurred and if such testing was clinically indicated, authors analyzed records of 85 patients transferred from one site to the other between January 1, 2006 and December 31, 2007. Duplication of testing (repeat within 12 hours) was found in 32% of the cases examined; 20% of cases had at least one duplicate test not clinically indicated. While previous studies document that inaccessibility of paper records leads to duplicate testing when patients are transferred between care facilities, the current study suggests that incomplete electronic record transfer among incompatible electronic medical record systems can also lead to potentially costly duplicate testing behaviors. The authors believe that interoperable systems with integrated decision support could assist in minimizing duplication of testing at time of patient transfers.
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Affiliation(s)
- Bridget A Stewart
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
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Vendittelli F, Brunel S, Veillard JJ, Gerbaud L, Lémery D. [The evaluation of the level of integration within a perinatal network]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2009; 38:559-73. [PMID: 19819647 DOI: 10.1016/j.jgyn.2009.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 05/27/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our goal was to evaluate the level of integration of general practitioners within the perinatal network in the Auvergne. MATERIALS AND METHODS A cross-sectional study was realized. The questionnaire was sent by post to the 1346 general practitioners who were members of the "Union régionale des médecins libéraux" (Regional association of private doctors in the Auvergne). Follow-up phone calls were also made. RESULTS The overall response to the questionnaire was 29.8%. Of those who replied, 76.3% were involved in the care of pregnant women or newly born babies. Among them, 51.2% had a consultation with a pregnant woman less than once a week and 53,5% had a consultation with a newly born more than once a week. A third were aware of the network and 25.7% had knowledge of the medical record provided by the network. Among them, 91.3% thought that a common medical record was necessary to improve the coordination of care. The answers differed according to age, area of responsibility, the administrative geographic position in the Auvergne, type of practise (hospital, private), and the sex of those who replied. CONCLUSION Despite a high a priori agreement, we must improve the level of information and training given to general practitioners within our perinatal network.
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Affiliation(s)
- F Vendittelli
- Réseau de santé périnatal d'Auvergne, pôle de gynécologie-obstétrique, maternité de l'Hôtel-Dieu, CHU de Clermont-Ferrand, boulevard Léon-Malfreyt, 63058 Clermont-Ferrand cedex 1, France.
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Electronic versus dictated hospital discharge summaries: a randomized controlled trial. J Gen Intern Med 2009; 24:995-1001. [PMID: 19609623 PMCID: PMC2726886 DOI: 10.1007/s11606-009-1053-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 05/11/2009] [Accepted: 06/03/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patient care transitions are periods of enhanced risk. Discharge summaries have been used to communicate essential information between hospital-based physicians and primary care physicians (PCPs), and may reduce rates of adverse events after discharge. OBJECTIVE To assess PCP satisfaction with an electronic discharge summary (EDS) program as compared to conventional dictated discharge summaries. DESIGN Cluster randomized trial. PARTICIPANTS Four medical teams of an academic general medical service. MEASUREMENTS The primary endpoint was overall discharge summary quality, as assessed by PCPs using a 100-point visual analogue scale. Other endpoints included housestaff satisfaction (using a 100-point scale), adverse outcomes after discharge (combined endpoint of emergency department visits, readmission, and death), and patient understanding of discharge details as measured by the Care Transition Model (CTM-3) score (ranging from 0 to 100). RESULTS 209 patient discharges were included over a 2-month period encompassing 1 housestaff rotation. Surveys were sent out for 188 of these patient discharges, and 119 were returned (63% response rate). No difference in PCP-reported overall quality was observed between the 2 methods (86.4 for EDS vs. 84.3 for dictation; P = 0.53). Housestaff found the EDS significantly easier to use than conventional dictation (86.5 for EDS vs. 49.2 for dictation; P = 0.03), but there was no difference in overall housestaff satisfaction. There was no difference between discharge methods for the combined endpoint for adverse outcomes (22 for EDS [21%] vs. 21 for dictation [20%]; P = 0.89), or for patient understanding of discharge details (CTM-3 score 80.3 for EDS vs. 81.3 for dictation; P = 0.81) CONCLUSION An EDS program can be used by housestaff to more easily create hospital discharge summaries, and there was no difference in PCP satisfaction.
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Affiliation(s)
- Robert J Reid
- Group Health Center for Health Studies, 1730 Minor Ave., Suite 1600, Seattle WA 98101, USA.
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