Measuring Primary Care Exam Length Using Electronic Health Record Data
Measuring Primary Care Exam Length Using Electronic Health Record Data
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DOI：
10.1097/mlr.0000000000001450
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发表时间：
2021-01-01
期刊：
影响因子：
3
通讯作者：
Cross, Dori A.
中科院分区：
文献类型：
--
作者：
Neprash, Hannah T.;Everhart, Alexander;Cross, Dori A.
背景：医生与患者在一起的时间是护理的关键投入，但通常是通过调查工具回顾性测量的。通过使用电子健康记录（EHRs）收集的数据提供了测量就诊时间的另一种方法。目的：测量初级保健医生在每次就诊期间与患者相处的时间。研究设计：我们使用来自一家大型卫生信息技术公司的全国初级保健实践电子病历数据来源。为了考虑非实时EHR使用和临床多任务处理，我们实施了顺序数据优化，根据EHR记录的时间戳计算了检查长度和时间表偏差。观察性分析计算并绘制了检查长度和检查长度相对于计划就诊长度的平均值、中位数和四分位数范围。对象：2017年共计21010,780次初级保健就诊。测量方法：我们确定了基于医生专业的初级保健就诊。对于这些访问，我们提取了考试期间EHR活动的时间戳。我们还从EHR的实践管理功能中提取了预定的访问时间。结果：经过数据优化后，初级保健检查的平均时间为18.0分钟（SD=13.5分钟）。平均而言，考试时间比预定时间晚1.2分钟（SD=13.5分钟）。预约10或15分钟的探访比预约20或30分钟的探访更有可能超过分配的时间。结论：带时间戳的电子病历数据为研究人员和卫生系统提供了一个测量检查长度和其他与时间相关的感兴趣对象的机会。
Background: Physicians' time with patients is a critical input to care, but is typically measured retrospectively through survey instruments. Data collected through the use of electronic health records (EHRs) offer an alternative way to measure visit length. Objective: To measure how much time primary care physicians spend with their patients, during each visit. Research Design: We used a national source of EHR data for primary care practices, from a large health information technology company. We calculated exam length and schedule deviations based on timestamps recorded by the EHR, after implementing sequential data refinements to account for non-real-time EHR use and clinical multitasking. Observational analyses calculated and plotted the mean, median, and interquartile range of exam length and exam length relative to scheduled visit length. Subjects: A total of 21,010,780 primary care visits in 2017. Measures: We identified primary care visits based on physician specialty. For these visits, we extracted timestamps for EHR activity during the exam. We also extracted scheduled visit length from the EHR's practice management functionality. Results: After data refinements, the average primary care exam was 18.0 minutes long (SD=13.5 min). On average, exams ran later than their scheduled duration by 1.2 minutes (SD=13.5 min). Visits scheduled for 10 or 15 minutes were more likely to exceed their allotted time than visits scheduled for 20 or 30 minutes. Conclusions: Time-stamped EHR data offer researchers and health systems an opportunity to measure exam length and other objects of interest related to time.