Electronic Medical Record Reminders and Panel Management to Improve Primary Care of Elderly Patients
Electronic Medical Record Reminders and Panel Management to Improve Primary Care of Elderly Patients
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DOI：
10.1001/archinternmed.2011.394
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发表时间：
2011-09-26
影响因子：
--
通讯作者：
Hamel, Mary Beth
中科院分区：
文献类型：
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作者：
Loo, Timothy S.;Davis, Roger B.;Hamel, Mary Beth
背景资料：大多数老年患者没有接受推荐的预防性护理、急性护理和慢性病护理。方法：我们进行了一项对照试验，评估电子病历（EMR）提醒（有或没有小组管理）在医疗保健代理指定、骨质疏松症筛查以及65岁以上患者的流感和肺炎球菌疫苗接种方面的有效性。医生被分配到以下3个组中的一个：EMR提醒、EMR提醒加面板管理器或对照组。我们评估完成推荐的做法在1年periods.Results：在患者谁还没有收到推荐的护理，医疗保健代理被指定在6.5%的患者在控制臂，8.8%的EMR提醒臂，和19.7%的EMR提醒加面板管理器臂（P = 0.002）。对照组中17.7%的患者完成了骨密度筛查，EMR提醒组中19.7%的患者完成了骨密度筛查，EMR提醒加面板管理器组中30.5%的患者完成了骨密度筛查（P = 0.02）。对照组中13.1%的患者接种了肺炎球菌疫苗，EMR提醒组中19.5%的患者接种了肺炎球菌疫苗，EMR提醒加面板管理器组中25.6%的患者接种了肺炎球菌疫苗（P = 0.02）。对照组中46.8%的患者接种了流感疫苗，EMR提醒组中56.5%的患者接种了流感疫苗，EMR提醒加面板管理器组中59.7%的患者接种了流感疫苗（P = .002）。结果是相似的调整个别医生的表现在前一年，病人的年龄，病人的性别，年照顾的做法，和visits.Conclusions数量：电子病历提醒单促进提高疫苗接种率，当面板管理增强，促进进一步提高疫苗接种率，提高医疗保健代理指定和骨密度筛查的比率。
Background: Most elderly patients do not receive recommended preventive care, acute care, and care for chronic conditions.Methods: We conducted a controlled trial to assess the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on health care proxy designation, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years. Physicians were assigned to 1 of the following 3 arms: EMR reminder, EMR reminder plus panel manager, or control. We assessed completion of recommended practices during a 1-year period.Results: Among patients who had not already received the recommended care, health care proxy was designated in 6.5% of patients in the control arm, 8.8% of the EMR reminder arm, and 19.7% of the EMR reminder plus panel manager arm (P = .002). Bone density screening was completed in 17.7% of patients in the control arm, 19.7% of the EMR reminder arm, and 30.5% of the EMR reminder plus panel manager arm (P = .02). Pneumococcal vaccine was given to 13.1% of patients in the control arm, 19.5% of the EMR reminder arm, and 25.6% of the EMR reminder plus panel manager arm (P = .02). Influenza vaccine was given to 46.8% of patients in the control arm, 56.5% of the EMR reminder arm, and 59.7% of the EMR reminder plus panel manager arm (P = .002). Results were similar when adjusted for individual physician performance in the preceding year, patient age, patient sex, years cared for by the practice, and number of visits.Conclusions: Electronic medical record reminders alone facilitated improvement in vaccination rates and, when augmented by panel management, facilitated further improvement in vaccination rates and boosted the rates of health care proxy designation and bone density screening.