Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
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DOI：
10.1093/jamia/ocac036
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发表时间：
2022-05-11
影响因子：
6.4
通讯作者：
Singh, Hardeep
中科院分区：
文献类型：
--
作者：
Giardina, Traber D.;Choi, Debra T.;Upadhyay, Divvy K.;Korukonda, Saritha;Scott, Taylor M.;Spitzmueller, Christiane;Schuerch, Conrad;Torretti, Dennis;Singh, Hardeep
《21世纪世纪治愈法案》规定，患者必须访问其电子健康记录（EHR）笔记。据我们所知，没有以前的工作系统地邀请患者主动报告诊断问题，同时记录和跟踪他们的诊断经验，通过电子病历为基础的临床医生笔记审查。测试患者是否可以通过对其在线访视记录进行结构化评估来识别对其诊断的担忧。在一个大型综合卫生系统中，如果EHR算法在初始初级保健咨询（“风险”访视）后检测到任何近期意外回访，则邀请2019年10月至2020年2月期间积极使用患者门户网站的18-85岁患者回答在线问卷。我们开发并测试了一种仪器（Safer Dx患者仪器），以帮助患者根据笔记审查和最近“风险”访视的回忆识别与诊断过程的几个维度相关的问题。其他问题评估了患者对医疗服务提供者的信任以及他们对就诊的总体感受。主要结局是自我报告的诊断问题。多变量logistic回归检验主要结局是否可通过工具变量预测。在293566次访视中，该算法确定了1282例合格患者，其中486例应答。在应用排除标准后，418例患者被纳入分析。51例患者（12.2%）发现了诊断问题。如果患者不同意“医疗服务提供者为我制定的护理计划解决了我所有的医疗问题”[比值比（OR），2.65; 95%置信区间（CI），1.45-4.87]和“我信任我在就诊期间看到的医疗服务提供者”，（OR，2.10; 95% CI，1.19-3.71），并同意“我对我的访视感觉不好”的陈述（OR，1.48; 95% CI，1.09-2.01）。患者可以根据访视记录的主动在线结构化评估来确定诊断问题。这一监测战略有可能提高诊断过程的透明度。
The 21st Century Cures Act mandates patients’ access to their electronic health record (EHR) notes. To our knowledge, no previous work has systematically invited patients to proactively report diagnostic concerns while documenting and tracking their diagnostic experiences through EHR-based clinician note review. To test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes. In a large integrated health system, patients aged 18–85 years actively using the patient portal and seen between October 2019 and February 2020 were invited to respond to an online questionnaire if an EHR algorithm detected any recent unexpected return visit following an initial primary care consultation (“at-risk” visit). We developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to several dimensions of the diagnostic process based on notes review and recall of recent “at-risk” visits. Additional questions assessed patients’ trust in their providers and their general feelings about the visit. The primary outcome was a self-reported diagnostic concern. Multivariate logistic regression tested whether the primary outcome was predicted by instrument variables. Of 293 566 visits, the algorithm identified 1282 eligible patients, of whom 486 responded. After applying exclusion criteria, 418 patients were included in the analysis. Fifty-one patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements “the care plan the provider developed for me addressed all my medical concerns” [odds ratio (OR), 2.65; 95% confidence interval [CI], 1.45–4.87) and “I trust the provider that I saw during my visit” (OR, 2.10; 95% CI, 1.19–3.71) and agreed with the statement “I did not have a good feeling about my visit” (OR, 1.48; 95% CI, 1.09–2.01). Patients can identify diagnostic concerns based on a proactive online structured evaluation of visit notes. This surveillance strategy could potentially improve transparency in the diagnostic process.
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影响因子：
9.7
作者：
Giardina, Traber Davis;Haskell, Helen;Singh, Hardeep
通讯作者：
Singh, Hardeep
影响因子：
2.2
作者：
Bell, Sigall K.;Folcarelli, Patricia;Bourgeois, Fabienne
通讯作者：
Bourgeois, Fabienne
DOI：
10.13063/2327-9214.1080
发表时间：
2014-01-01
期刊：
EGEMS (Washington, DC)
影响因子：
--
作者：
Dullabh, Prashila M;Sondheimer, Norman K;Evans, Michael A
通讯作者：
Evans, Michael A
影响因子：
19.7
作者：
Larson, David B.;Donnelly, Lane F.;Kruskal, Jonathan B.
通讯作者：
Kruskal, Jonathan B.
影响因子：
5.4
作者：
Bell, Sigall K.;Mejilla, Roanne;Walker, Jan
通讯作者：
Walker, Jan