The next step towards making use meaningful: electronic information exchange and care coordination across clinicians and delivery sites.
The next step towards making use meaningful: electronic information exchange and care coordination across clinicians and delivery sites.
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DOI：
10.1097/mlr.0000000000000245
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发表时间：
2014-12
期刊：
影响因子：
3
通讯作者：
Hsu J
中科院分区：
文献类型：
--
作者：
Graetz I;Reed M;Shortell SM;Rundall TG;Bellows J;Hsu J
对慢性病患者的护理通常需要多名医生和分娩地点之间的协调。电子健康记录（EHR）的使用可以通过促进护理协调来提高护理质量和效率。我们研究了EHR的使用和临床医生对跨临床医生和分娩地点转移的患者的护理协调的看法之间的关联。在交错实施门诊EHR（2005-2008年）和综合住院EHR（2006-2010年）期间，对初级保健临床医生进行了重复调查。我们测量了EHR使用阶段（未使用，仅门诊EHR和综合住院-门诊EHR）和护理协调之间的关联，使用logistic回归，调整临床医生特征，研究年份和医疗中心。成人初级保健临床医生在一个大型综合交付系统。临床医生报告的患者护理协调的三项措施在临床医生之间转移（例如，从专家到初级护理团队）和跨递送站点（例如，从医院到门诊）。门诊EHR的使用与获得完整和及时的临床信息的更多报告以及对跨临床医生转移的患者的临床医生角色和责任的更高一致性相关，但不适用于跨交付站点转移的患者。使用综合门诊-住院EHR与获得及时和完整的临床信息的报告增加、临床医生同意跨分娩站点转移患者的治疗计划以及跨临床医生转移患者的所有协调措施相关。使用集成的电子健康记录，在整个交付环境中交换健康信息，改善了患者护理协调。
Care for patients with chronic conditions often requires coordination between multiple physicians and delivery sites. Electronic Health Record (EHR) use could improve care quality and efficiency in part by facilitating care coordination. We examined the association between EHR use and clinician perceptions of care coordination for patients transferred across clinicians and delivery sites. Repeated surveys of primary care clinicians during the staggered implementation of an outpatient EHR (2005-2008), followed by an integrated inpatient EHR (2006-2010). We measured the association between EHR use stages (no use, outpatient EHR only, and integrated inpatient-outpatient EHR) and care coordination using logistic regression, adjusting for clinician characteristics, study year, and medical center. Adult primary care clinicians in a large integrated delivery system. Three measures of clinician-reported care coordination for patient care transferred across clinicians (e.g., from specialist to primary care team) and across delivery sites (e.g., from the hospital to outpatient care). Outpatient EHR use was associated with higher reports of access to complete and timely clinical information and higher agreement on clinician roles and responsibilities for patients transferred across clinicians, but not for patients transferred across delivery sites. Use of the integrated outpatient-inpatient EHR was associated with higher reports of access to timely and complete clinical information, clinician agreement on the patient's treatment plan for patients transferred across delivery sites, and with all coordination measures for patients transferred across clinicians. Use of an integrated EHR with health information exchange across delivery settings improved patient care coordination.