Leveraging electronic health records to develop measurements for processes of care.
Leveraging electronic health records to develop measurements for processes of care.
复制标题
利用电子健康记录来开发护理过程的测量方法。
DOI：
10.1111/1475-6773.12126
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发表时间：
2014
影响因子：
3.4
通讯作者：
Chung,Sukyung
中科院分区：
文献类型：
--
作者：
Tai-Seale,Ming;Wilson,CarolineJ;Panattoni,Laura;Kohli,Nidhi;Stone,Ashley;Hung,DorothyY;Chung,Sukyung
评估电子健康记录（EHR）中用于测量初级保健医生（PCP）护理过程的数据的可靠性，并检查这些测量与临床结局之间的关系。数据来源/研究设置来自15，370名糖尿病患者、49，561名高血压患者、研究设计/方法探索性因素分析（EFA）和多层次分析的护理变量和因素规模的控制血红蛋白A1 c，血压（BP），和低密度脂蛋白（LDL）在糖尿病患者和血压高血压患者。主要发现电子邮件的数量，天数的第三下一个可用的预约，和团队沟通成为全民教育中PCP护理过程的可靠因素（Cronbach的α = 0.73，0.62和0.91）。在糖尿病患者中，电子邮件的数量与LDL控制（≤100）的几率较高相关（OR = 1.13，p <0.05）。在糖尿病患者中，频繁的亲自就诊与更好的血压（OR = 1.02，p < .01）和低密度脂蛋白控制（OR = 1.01，p < .01）相关，在高血压患者中，与更好的血压控制（OR = 1.04，p < .01）相关。结论EHR提供了护理措施流程，可以增强患者报告的以患者为中心的措施。其中两个与临床结果显著相关。未来的研究应该检查它们与其他结果的关联。
ObjectivesTo assess the reliability of data in electronic health records (EHRs) for measuring processes of care among primary care physicians (PCPs) and examine the relationship between these measures and clinical outcomes.Data Sources/Study SettingEHR data from 15,370 patients with diabetes, 49,561 with hypertension, in a group practice serving four Northern California counties.Study Design/MethodsExploratory factor analysis (EFA) and multilevel analyses of the relationships between processes of care variables and factor scales with control of hemoglobin A1c, blood pressure (BP), and low density lipoprotein (LDL) among patients with diabetes and BP among patients with hypertension.Principal FindingsVolume of e‐messages, number of days to the third‐next‐available appointment, and team communication emerged as reliable factors of PCP processes of care in EFA (Cronbach's alpha = 0.73, 0.62, and 0.91). Volume of e‐messages was associated with higher odds of LDL control (≤100) (OR = 1.13,p< .05) among patients with diabetes. Frequent in‐person visits were associated with better BP (OR = 1.02,p< .01) and LDL control (OR = 1.01,p< .01) among patients with diabetes, and better BP control (OR = 1.04,p< .01) among patients with hypertension.ConclusionsThe EHR offers process of care measures which can augment patient‐reported measures of patient‐centeredness. Two of them are significantly associated with clinical outcomes. Future research should examine their association with additional outcomes.