Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review.
Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review.
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DOI：
10.1186/s12913-016-1373-y
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发表时间：
2016-04-22
影响因子：
2.8
通讯作者：
Bates DW
中科院分区：
文献类型：
--
作者：
Samal L;Dykes PC;Greenberg JO;Hasan O;Venkatesh AK;Volk LA;Bates DW
健康信息技术(HIT)可以通过为临床医生提供远程信息访问、提高易读性和允许异步通信等机制来改善护理协调。我们试图从临床医生的角度确定在美国各地的急诊科、急性护理医院、熟练护理机构和家庭健康机构之间转移患者时，如何协调护理以及在多大程度上涉及HIT。我们对来自美国六个地区的临床医生和信息技术专业人员进行了定性研究，这些地区被选为HIT领域的国家领导者。我们通过两人协商一致的方法分析数据，为九项护理协调活动中的每一项分配回应。我们还对MEDLINE®、CINAHL®和Embase进行了文献综述，分析了旨在改善护理过渡期间信息传输的干预措施的研究结果。我们招募了来自17个组织的29名受访者，并进行了6个焦点小组。受访者报告了HIT目前如何用于护理协调活动。HIT目前用于监测患者，并使系统级别的资源与人口需求保持一致。然而，我们确定了缺乏互操作性导致流程低效和数据丢失的多个领域。此外，文献综述确定了10项针对信息传递的干预研究，其中7项采用了HIT，3项采用了其他沟通方法，如电话、传真记录和护士病例管理。由于全美缺乏互操作性，护理协调存在重大差距。我们必须设计、评估和激励使用HIT进行护理协调。我们应该专注于我们发现差距最大的领域：信息传输、监控患者的系统、支持患者自我管理目标的工具，以及将患者及其照顾者与社区资源联系起来的工具。这篇文章的在线版本(doi：10.1186/s12913-016-第1373-y)载有补充材料，可供授权用户查阅。
Health information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms. We sought to determine, from a clinician perspective, how care is coordinated and to what extent HIT is involved when transitioning patients between emergency departments, acute care hospitals, skilled nursing facilities, and home health agencies in settings across the United States. We performed a qualitative study with clinicians and information technology professionals from six regions of the U.S. which were chosen as national leaders in HIT. We analyzed data through a two person consensus approach, assigning responses to each of nine care coordination activities. We also conducted a literature review of MEDLINE®, CINAHL®, and Embase, analyzing results of studies that examined interventions to improve information transfer during transitions of care. We enrolled 29 respondents from 17 organizations and conducted six focus groups. Respondents reported how HIT is currently used for care coordination activities. HIT is currently used to monitor patients and to align systems-level resources with population needs. However, we identified multiple areas where the lack of interoperability leads to inefficient processes and missing data. Additionally, the literature review identified ten intervention studies that address information transfer, seven of which employed HIT and three of which utilized other communication methods such as telephone calls, faxed records, and nurse case management. Significant care coordination gaps exist due to the lack of interoperability across the United States. We must design, evaluate, and incentivize the use of HIT for care coordination. We should focus on the domains where we found the largest gaps: information transfer, systems to monitor patients, tools to support patients’ self-management goals, and tools to link patients and their caregivers with community resources. The online version of this article (doi:10.1186/s12913-016-1373-y) contains supplementary material, which is available to authorized users.