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Development and evaluation of notifications to inform primary care providers of summary documentation for their patients' hospital visits.

机译：开发和评估通知，以告知初级保健提供者患者就诊的简要文档。

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摘要

The transition of care patients experience when they are discharged from inpatient or emergency department (ED) care often suffers from poor communication that has the potential to result in adverse events. The purpose of this dissertation was to design and evaluate a system to notify the primary care provider (PCP) named in a patient's admission record when new discharge summary documentation is stored to their patients' electronic medical records (EMRs). This system was built and evaluated within the Intermountain Healthcare HELP2 EMR system.;A randomized controlled trial (RCT) of the system was conducted in which six clinics were selected and randomly assigned to a control or intervention group. Providers at intervention clinics were sent notifications when summary documentation was created for hospital encounters for which they were named as a patient's PCP.;A concurrent study found that other data types might outperform the current method of predicting follow-up providers (using the PCP named in the patient's admission record). The best performing predictor of future follow-up records was a patient's past appointment history. Unfortunately, even this "best" predictor only had a sensitivity of 48% and a positive predictive value of 34%.;The final RCT analysis found that provider access of summary documents was significantly higher among intervention group providers than among control providers (80% of discharge summaries and 56% of ED summaries, compared to 65% and 25%) and occurred significantly sooner. Follow-up care process outcomes, including time from discharge to follow-up, and hospital and emergency readmission rates, were also measured, but no significant improvement was seen in the intervention group. A survey of intervention providers showed high rates of satisfaction with the system.;The notifications were a simple, yet effective, means of improving communication at the discharge transition. It is possible that improvement in follow-up care processes might also be seen if the notifications are updated to include mechanisms for acting on this new information. However, without changes in primary care reimbursement, PCPs will still be hard-pressed to find time for preventive care.;Future plans include updates to the notification design, and an expansion to include notifications for other clinical events.
机译：当患者从住院或急诊室（ED）出院时，他们经历的过渡通常是沟通不畅，有可能导致不良事件。本文的目的是设计和评估一种系统，以在新出院摘要文档存储到患者的电子病历（EMR）中时通知患者入院记录中指定的初级保健提供者（PCP）。该系统是在Intermountain Healthcare HELP2 EMR系统中构建和评估的。进行了该系统的随机对照试验（RCT），其中选择了六个诊所并将其随机分配到对照组或干预组。干预诊所的提供者在为遇到的医院遭遇创建摘要文档时将通知发送给他们，将其命名为患者的PCP。一项并行研究发现，其他数据类型可能优于当前的预测随访提供者的方法（使用名为PCP的PCP）。在患者的入院记录中）。未来随访记录中表现最好的预测指标是患者过去的约会历史。不幸的是，即使是这种“最佳”预测变量，其敏感性也只有48％，阳性预测值为34％。；最终RCT分析发现，干预组提供者对摘要文档的提供者访问比对照提供者要高得多（80％排放汇总和ED汇总的56％，而65％和25％）发生的时间要早​​得多。还测量了随访护理过程的结局，包括从出院到随访的时间，以及医院和紧急情况的再入院率，但干预组未见明显改善。一项对干预提供者的调查显示，对该系统的满意度很高。通知是一种简单但有效的方法，可以改善排放过渡时的沟通。如果通知被更新为包括对新信息采取行动的机制，则可能还会看到后续护理流程的改善。但是，如果不改变初级保健报销额，PCP仍然很难找到预防性护理的时间。未来计划包括对通知设计的更新，以及扩展到包括针对其他临床事件的通知。

著录项

  • 作者

    Tripp, Jacob Stewart.;

  • 作者单位

    The University of Utah.;

  • 授予单位 The University of Utah.;
  • 学科 Information Science.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 195 p.
  • 总页数 195
  • 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

  • 入库时间 2022-08-17 11:38:24

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