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Information and communication technologies in patient-centered healthcare redesign: Qualitative studies of provider experience.

机译：重新设计以患者为中心的医疗保健中的信息和通信技术：对提供者经验的定性研究。

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摘要

Promoting widespread availability and provider adoption of electronic medical records is a core component of current efforts to reform healthcare in the United States. Initiatives to redesign healthcare to achieve quality improvement, patient access, economic sustainability, and other reforms often seek to leverage the potential of electronic medical records and other information and communication technologies. However, the evidence pertaining to the effectiveness of these technologies in supporting and promoting these objectives is limited, and their adoption among healthcare providers remains low---particularly in primary care and other ambulatory care settings. Given both the questionable sustainability of primary care and its central role in current healthcare reform initiatives, there is a critical need to inform these endeavors with empirically-derived knowledge of how information and communication technologies affect healthcare providers and their efforts to redesign care to better meet the needs of their patients and communities. This dissertation explores provider perspectives on the roles, importance, and effects (both positive and negative) of healthcare information and communication technologies in the context of patient-centered healthcare redesign. Three qualitative observational studies were conducted at Group Health Cooperative, a large integrated healthcare delivery system serving patients throughout the Pacific Northwest. These studies were informed by Donabedian's framework for evaluating healthcare quality, Rogers' Diffusion of Innovations Theory, and the Tavistock Institute's Sociotechnical Systems Theory. Findings revealed provider and organizational perspectives on their experiences with implementing and using a commercial clinical information system (EpicCare Ambulatory EMR) with an integrated patient Web portal, patient-provider email, internal clinical messaging, an internally-developed online health risk assessment application, and other information and communication technologies. Participants expressed sharply contrasting perspectives on the same technologies viewed as components of two unique practice redesign initiatives---an organization-wide redesign of operations to implement Patient-Centered Access, and a single clinic redesign to implement the Patient-Centered Medical Home model. These findings suggested that contextual factors such as the care redesign methods and the care models used to guide care redesign are key determinants of the effects associated with the implementation and use of these technologies. This dissertation contributes to the literature on sociotechnical approaches to technology-enabled healthcare redesign and evaluation by describing how instances of these different care redesign models incorporated the various technologies, and by evaluating providers' perspectives on their roles, importance, and effects.
机译：促进电子病历的广泛普及和提供商采用是当前美国医疗保健改革工作的核心内容。重新设计医疗保健以实现质量改善，患者就诊，经济可持续性以及其他改革的举措通常试图利用电子病历和其他信息和通讯技术的潜力。但是，与这些技术在支持和促进这些目标方面的有效性有关的证据有限，而且在医疗保健提供者中采用率仍然很低，尤其是在初级保健和其他非卧床护理环境中。鉴于初级保健的可持续性令人怀疑，并且其在当前医疗改革计划中的核心作用不容忽视，因此迫切需要以经验为基础的知识为这些工作提供信息和通信技术如何影响医疗保健提供者以及他们重新设计护理以更好地满足其需求的知识。他们的病人和社区的需求。本文探讨了医疗服务提供者在以患者为中心的医疗保健重新设计的背景下，对医疗保健信息和通信技术的作用，重要性和作用（正面和负面）的观点。在Group Health Cooperative进行了三项定性观察研究，Group Health Cooperative是为整个西北太平洋地区的患者提供服务的大型综合医疗保健提供系统。这些研究得益于Donabedian评估医疗质量的框架，Rogers的创新扩散理论和Tavistock研究所的社会技术系统理论。调查结果揭示了提供者和组织对他们在实施和使用带有集成患者Web门户，患者提供者电子邮件，内部临床消息，内部开发的在线健康风险评估应用程序的商业临床信息系统（EpicCare Ambulatory EMR）方面的经验的看法；以及其他信息和通信技术。与会者对被视为两项独特的实践重新设计计划的组成部分的同一技术形成了截然不同的看法，这两项创新是一项全组织范围内的业务重新设计以实施以患者为中心的访问，而一次诊所重新设计以实施以患者为中心的医疗之家模型。这些发现表明，诸如护理重新设计方法和用于指导护理重新设计的护理模型等情境因素是与这些技术的实施和使用相关的影响的关键决定因素。本论文通过描述这些不同的护理重新设计模型的实例如何结合各种技术，并通过评估提供者对其作用，重要性和效果的观点，为有关以技术为基础的医疗保健重新设计和评估的社会技术方法的文献做出了贡献。

著录项

  • 作者

    Tufano, James T.;

  • 作者单位

    University of Washington.;

  • 授予单位 University of Washington.;
  • 学科 Information Science.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 224 p.
  • 总页数 224
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 信息与知识传播;预防医学、卫生学;
  • 关键词

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