Office-Based Tools and Primary Care Visit Communication, Length, and Preventive Service Delivery
Office-Based Tools and Primary Care Visit Communication, Length, and Preventive Service Delivery
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DOI：
10.1111/1475-6773.12348
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发表时间：
2016-04-01
影响因子：
3.4
通讯作者：
Street, Richard L.
中科院分区：
文献类型：
--
作者：
Lafata, Jennifer Elston;Shay, L. Aubree;Street, Richard L.
背景鼓励使用基于医生办公室的工具，如电子健康记录（EHR），健康风险评估（HRA）工具和书面患者提醒列表，以支持高效，高质量，以患者为中心的护理。我们评估协会的检查室使用EHRs，HRA仪器，和自我生成的书面患者提醒列表与患者-医生沟通行为，建议预防性卫生服务的提供，和visitlength.Research MethodsObservational研究485个办公室访问64个初级保健医生执业的卫生系统服务底特律大都市区。研究数据来自患者调查、直接观察、诊室访视录音和自动化健康系统记录。结果指标包括就诊时间（分钟）、患者使用积极沟通行为、医生使用支持性谈话和建立伙伴关系的沟通行为以及患者有资格和应得的指南推荐的预防性健康服务的百分比。同时线性回归模型被用来评估工具使用和结果之间的关联。调整后的模型控制患者特征，医生特征，患者和医生之间的关系特征，以及访问发生的环境特征。平均使用EHR的访问次数显著增加，（第05页）调整后的模型，但HRA使用和预防性服务提供之间的模型除外。传播和实施影响办公室-旨在促进实施所需的初级保健实践重新设计的基础工具与积极和消极的成本和质量结果相关。调查结果强调，需要监测的预期和意外的后果，办公室为基础的工具，常用的初级保健实践的重新设计。
BackgroundThe use of physician office-based tools such as electronic health records (EHRs), health risk appraisal (HRA) instruments, and written patient reminder lists is encouraged to support efficient, high-quality, patient-centered care. We evaluate the association of exam room use of EHRs, HRA instruments, and self-generated written patient reminder lists with patient-physician communication behaviors, recommended preventive health service delivery, and visit length.Research MethodsObservational study of 485 office visits with 64 primary care physicians practicing in a health system serving the Detroit metropolitan area. Study data were obtained from patient surveys, direct observation, office visit audio-recordings, and automated health system records. Outcome measures included visit length in minutes, patient use of active communication behaviors, physician use of supportive talk and partnership-building communication behaviors, and percentage of delivered guideline-recommended preventive health services for which patients are eligible and due. Simultaneous linear regression models were used to evaluate associations between tool use and outcomes. Adjusted models controlled for patient characteristics, physician characteristics, characteristics of the relationship between the patient and physician, and characteristics of the environment in which the visit took place.ResultsPrior to adjusting for other factors, visits in which the EHR was used on average were significantly (p.05) in adjusted models with the exception of that between HRA use and preventive service delivery.Dissemination and Implementation ImplicationsOffice-based tools intended to facilitate the implementation of desired primary care practice redesign are associated with both positive and negative cost and quality outcomes. Findings highlight the need for monitoring both intended and unintended consequences of office-based tools commonly used in primary care practice redesign.