Electronic care coordination systems for people with advanced progressive illness: a mixed-methods evaluation in Scottish primary care
Electronic care coordination systems for people with advanced progressive illness: a mixed-methods evaluation in Scottish primary care
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DOI：
10.3399/bjgp19x707117
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发表时间：
2020-01-01
影响因子：
5.9
通讯作者：
Murray, Scott A.
中科院分区：
文献类型：
--
作者：
Finucane, Anne M.;Davydaitis, Deborah;Murray, Scott A.
背景电子护理协调系统在苏格兰被称为关键信息摘要(KIS)，能够创建跨医疗保健设置可用的共享电子记录。KIS为临床医生提供必要的信息，以指导可能需要紧急或非工作时间护理的人的决策。目的估计死亡时KIS晚期进展性疾病的比例，检查何时记录计划信息，并建议改进电子护理协调系统。设计和设置这是一项混合方法研究，涉及苏格兰18种不同的全科医生。方法回顾2017年死亡患者的医疗记录，并与医疗专业人员进行半结构化访谈。结果收集了1304名死者的数据。在晚期进展性疾病患者中[79%，n=1034]，69%[n=712]有KIS。这些试验开始于死亡前45周的中位数。癌症患者最有可能患有KIS[80%，n=288]，而器官衰竭患者最不可能[47%，n=125]。总体而言，68%[n=482]的KIS包括复苏状态，55%[n=390]的KIS包括首选护理地点。有KIS的人比没有KIS的人更有可能在社区死亡[61%比30%]。大多数KIS被认为是有用的/非常有用的，KIS中最新的自由文本信息被高度重视。结论在苏格兰，大多数晚期进展性疾病患者在死亡时都有电子护理协调记录。这是一项成就。为了进一步完善，更好的非正式照顾者信息，定期更新。而且，有必要将重点放在为器官衰竭患者生成KIS上。
BackgroundElectronic care coordination systems, known as the Key Information Summary (KIS) in Scotland, enable the creation of shared electronic records available across healthcare settings. A KIS provides clinicians with essential information to guide decision making tor people likely to need emergency or out-of-hours care.AimTo estimate the proportion of people with an advanced progressive illness with a KIS by the time of death, to examine when planning information is documented, and suggest improvements for electronic care coordination systems.Design and settingThis was a mixed-inethods study involving 18 diverse general practices in Scotland.MethodRetrospective review of medical records of patients who died in 2017, and semi-structured interviews with healthcare professionals were conducted.ResultsData on 1304 decedents were collected. Of those with an advanced progressive illness [79%, n = 1034], 69%[n = 712] had a KIS. These were started a median of 45 weeks before death. People with cancer were most likely to have a KIS [80%, n = 288], and those with organ failure least likely [47% n =125]. Overall, 68% [n = 482] of KIS included resuscitation status and 55% [n = 390] preferred place of care. People with a KIS were more likely to die in the community compared to those without one [61% versus 30%]. Most KIS were considered useful/highly useful Up-to-date free-text information within the KIS was valued highly.ConclusionIn Scotland, most people with an advanced progressive illness have an electronic care coordination record by the time of death. This is an achievement. To improve further, better informal carer information, regular updating. and a focus on generating a KIS for people with organ failure is warranted.