Workflow analysis for design of an electronic health record-based tobacco cessation intervention in community health centers.
Workflow analysis for design of an electronic health record-based tobacco cessation intervention in community health centers.
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DOI：
10.1093/jamiaopen/ooaa070
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发表时间：
2021-07
期刊：
影响因子：
2.1
通讯作者：
Wetter DW
中科院分区：
文献类型：
--
作者：
Gibson B;Kramer H;Weir C;Fiol G;Borbolla D;Schlechter CR;Lam C;Nelson M;Bohner C;Schulthies S;Sieperas T;Pruhs A;Nahum-Shani I;Fernandez ME;Wetter DW
烟草使用是美国可预防的发病率和死亡率的主要原因。戒烟热线是基于电话的有效戒烟服务，但未得到充分利用。该项目的目标是描述当前戒烟热线转诊的临床工作流程，并为“询问-建议-连接”(AAC) 设计一个基于电子健康记录 (EHR) 的最佳工作流程，这是一种旨在增加戒烟热线转诊的循证干预措施。使用三种不同 EHR 的 10 个社区健康中心系统 (CHC) 参与了这项研究。方法包括：与 CHC 领导进行 9 次小组讨论； 33 次对临床团队工作流程的观察/访谈；对 57 名临床工作人员进行的调查；对每个 CHC 的 EHR 生态系统进行评估。根据个人、任务、技术和环境之间的契合度 (FITTE) 框架对这些方法的数据进行了集成和编码。当前和最佳工作流程是使用业务流程建模符号来表示的。我们将最佳工作流程的要求与 EHR 功能进行了比较。当前的工作流程在数据收集方面效率低下，制定戒烟建议和转诊的人员、方式和时间各不相同，并且转诊诊所和戒烟热线之间缺乏沟通。在最佳工作流程中，医疗助理在就诊期间提供标准化的 AAC 干预。转诊以电子方式提交，诊所和戒烟热线之间有双向沟通。我们在所有三个 EHR 中实施了 AAC；然而，偏离最佳工作流程是必要的。当前的戒烟热线转介工作流程效率低下且无效。我们提出了最佳工作流程，并讨论了 EHR 功能的改进，以改善 AAC 的实施。
Tobacco use is the leading cause of preventable morbidity and mortality in the United States. Quitlines are effective telephone-based tobacco cessation services but are underutilized. The goal of this project was to describe current clinical workflows for Quitline referral and design an optimal electronic health record (EHR)-based workflow for Ask-Advice-Connect (AAC), an evidence-based intervention to increase Quitline referrals. Ten Community Health Center systems (CHC), which use three different EHRs, participated in this study. Methods included: 9 group discussions with CHC leaders; 33 observations/interviews of clinical teams' workflow; surveys with 57 clinical staff; and assessment of the EHR ecosystem in each CHC. Data across these methods were integrated and coded according to the Fit between Individual, Task, Technology and Environment (FITTE) framework. The current and optimal workflow were notated using Business Process Modelling Notation. We compared the requirements of the optimal workflow with EHR capabilities. Current workflows are inefficient in data collection, variable in who, how, and when tobacco cessation advice and referral are enacted, and lack communication between referring clinics and the Quitline. In the optimal workflow, medical assistants deliver a standardized AAC intervention during the visit intake. Referrals are submitted electronically, and there is bidirectional communication between the clinic and Quitline. We implemented AAC within all three EHRs; however, deviations from the optimal workflow were necessary. Current workflows for Quitline referral are inefficient and ineffective. We propose an optimal workflow and discuss improvements in EHR capabilities that would improve the implementation of AAC.
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影响因子：
5.2
作者：
McAlister, AL;Rabius, V;Todd, R
通讯作者：
Todd, R
影响因子：
3.6
作者：
Adsit, Robert T.;Fox, Bradley M.;Fiore, Michael C.
通讯作者：
Fiore, Michael C.
通过基于证据的停止治疗和政策来促进人口退出。
影响因子：
5.5
作者：
Abrams DB;Graham AL;Levy DT;Mabry PL;Orleans CT
通讯作者：
Orleans CT
DOI：
10.1016/j.jcjq.2019.09.003
发表时间：
2019-12-01
影响因子：
2.3
作者：
Flocke, Susan A.;Seeholzer, Eileen;Kaelber, David C.
通讯作者：
Kaelber, David C.
影响因子：
3.6
作者：
Pineiro, Barbara;Vidrine, Damon J.;Vidrine, Jennifer, I
通讯作者：
Vidrine, Jennifer, I