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首页> 外文期刊>BMC Medical Informatics and Decision Making >Evaluating the impact of patients' online access to doctors' visit notes: designing and executing the OpenNotes project
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Evaluating the impact of patients' online access to doctors' visit notes: designing and executing the OpenNotes project

机译：评估患者在线访问医生的访视记录的影响：设计和执行OpenNotes项目

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Background Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices. Methods/Design Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention. Results PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38,000 patient surveys. Discussion Many primary care physicians were willing to participate in this "real world" experiment testing the impact of OpenNotes on their patients and their practices. Results from this trial will inform providers, policy makers, and patients who contemplate such changes at a time of exploding interest in transparency, patient safety, and improving the quality of care.
机译：背景提供者和政策制定者正在寻求战略，以增加患者对医疗保健的参与度。尽管很少包括临床医生的访问记录，但患者越来越多地可以查看在线病历。我们设计了一项在线患者可访问的办公室访问记录OpenNotes的一年期多站点试验。我们假设患者和初级保健医生（PCP）希望它继续下去，而OpenNotes不会导致医生行为的重大中断。方法/设计使用混合方法，我们在波士顿，宾夕法尼亚州和西雅图的3种不同的医疗系统中设计了一项准实验研究。有两个站点拥有现有的患者互联网门户;第三个使用实验门户。我们针对我们认为影响最大的三个关键领域：关于OpenNote的信念和态度，使用患者互联网门户网站以及患者与医生之间的交流。邀请了3个地点的PCP参加干预。作为参与PCP的已注册门户网站用户的患者可以使用其PCP的访问记录，有效期为一年。拒绝参与干预措施的PCP及其患者作为研究的比较组。我们将RE-AIM框架应用于我们的设计中，以便尽可能全面地了解OpenNotes的影响。我们根据与患者和医生的访谈和焦点小组，针对网络管理制定了干预前后的调查，以探讨态度和经验。此外，我们在干预之前和干预期间跟踪了Internet门户的使用。结果3个站点的PCP参与率从19％到87％不等;共有114位PCP与22,000位注册门户网站用户的患者一起参加了干预。 3个站点中约40％的干预和非干预患者对在线调查做出了回应，总共进行了约38,000例患者调查。讨论许多初级保健医生愿意参加这个“现实世界”实验，测试OpenNotes对他们的患者和实践的影响。该试验的结果将在透明性，患者安全性和改善护理质量引起人们的关注之时，向考虑此类变化的提供者，政策制定者和患者提供信息。

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