Not Perfect, but Better: Primary Care Providers' Experiences with Electronic Referrals in a Safety Net Health System
Not Perfect, but Better: Primary Care Providers' Experiences with Electronic Referrals in a Safety Net Health System
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DOI：
10.1007/s11606-009-0955-3
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发表时间：
2009-05-01
影响因子：
5.7
通讯作者：
Kushel, Margot B.
中科院分区：
文献类型：
--
作者：
Kim, Yeuen;Chen, Alice Hm;Kushel, Margot B.
电子转诊可以改善在安全网环境中获得专科护理的机会。2007年1月，旧金山弗朗西斯科总医院（SFGH）推出了一个电子转诊门户网站，该网站整合了亚专科分诊、与转诊提供者的反复沟通以及现有的电子健康记录数据，以改善亚专科护理的可及性。我们调查了初级保健提供者（PCP），以评估电子转诊对工作流程和临床护理的影响。我们管理了一个18项，对所有368名可以选择转诊到SFGH的PCP进行基于网络的问卷调查。我们要求参与者使用5分Likert量表对提交转诊所花费的时间、检查指导、等待时间以及与先前转诊方法相比的整体临床护理变化进行评分。我们使用多变量逻辑回归来确定与整体临床护理改善相关的变量。来自24家诊所的298名PCP（81.0%）参与了研究。超过一半（55.4%）在医院诊所工作，27.9%在县资助的社区诊所工作，17.1%在非县资助的社区诊所工作。大多数（71.9%）报告说，电子转诊改善了整体临床护理。来自非县资助诊所的提供者（AOR 0.40，95%CI 0.14-0.79）和花费千分之一日元6分钟提交电子转诊的患者（AOR 0.33，95%CI 0.18-0.61）与其他参与者相比，报告电子转诊改善了临床护理的可能性显著降低。那些报告对工作流程有负面影响的人不太可能同意。虽然电子转诊有望作为改善临床护理的工具，但应考虑其对工作流程的影响。
Electronic referrals can improve access to subspecialty care in safety net settings. In January 2007, San Francisco General Hospital (SFGH) launched an electronic referral portal that incorporated subspecialist triage, iterative communication with referring providers, and existing electronic health record data to improve access to subspecialty care.We surveyed primary care providers (PCPs) to assess the impact of electronic referrals on workflow and clinical care.We administered an 18-item, web-based questionnaire to all 368 PCPs who had the option of referring to SFGH.We asked participants to rate time spent submitting a referral, guidance of workup, wait times, and change in overall clinical care compared to prior referral methods using 5-point Likert scales. We used multivariate logistic regression to identify variables associated with perceived improvement in overall clinical care.Two hundred ninety-eight PCPs (81.0%) from 24 clinics participated. Over half (55.4%) worked at hospital-based clinics, 27.9% at county-funded community clinics, and 17.1% at non-county-funded community clinics. Most (71.9%) reported that electronic referrals had improved overall clinical care. Providers from non-county-funded clinics (AOR 0.40, 95% CI 0.14-0.79) and those who spent a parts per thousand yen6 min submitting an electronic referral (AOR 0.33, 95%CI 0.18-0.61) were significantly less likely than other participants to report that electronic referrals had improved clinical care.PCPs felt electronic referrals improved health-care access and quality; those who reported a negative impact on workflow were less likely to agree. While electronic referrals hold promise as a tool to improve clinical care, their impact on workflow should be considered.