Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data
Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data
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DOI：
10.1093/jamia/ocy184
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发表时间：
2019-06-01
影响因子：
6.4
通讯作者：
Gurses, Ayse P.
中科院分区：
文献类型：
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作者：
Durojaiye, Ashimiyu B.;Levin, Scott;Gurses, Ayse P.
目的：本研究旨在确定儿童创伤患者的协作电子健康记录（EHR）使用模式，并确定使用模式与患者预后的关系。材料和方法：将基于过程挖掘的网络分析应用于EHR元数据和创伤登记数据，用于一级儿科创伤中心的一组轻伤儿科创伤患者。EHR元数据被处理成事件日志，该日志根据事件时间连续性中的间隙进行分割。通过在同一事件日志段中捕获的功能角色之间创建边界，为每次遇到构建使用模式。利用图核和无监督谱聚类方法对这些模式进行分类。比较两组的人口学特征、临床和网络特征以及急诊科（ED）住院时间（LOS）。结果：发现了三种不同网络密度的不同使用模式：完全连接（派系）、部分连接和断开连接（孤立）。与完全连接模式相比，部分连接模式就诊的ED LOS调整中位数明显更长（242.6[95%置信区间，236.9-246.0]分钟vs 295.2[95%置信区间，289.2-297.8]分钟），在白班和工作日就诊的患者中更常见，涉及耳鼻喉科、眼科服务和儿童生活专家。讨论：在研究队列中，小团体式的使用模式与ED LOS降低有关，这表明更大程度的合作导致了更短的住院时间。结论：进一步调查了解和解决病因可以提高多学科合作水平。
Objectives: The study sought to identify collaborative electronic health record (EHR) usage patterns for pediatric trauma patients and determine how the usage patterns are related to patient outcomes.Materials and Methods: A process mining-based network analysis was applied to EHR metadata and trauma registry data for a cohort of pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The EHR metadata were processed into an event log that was segmented based on gaps in the temporal continuity of events. A usage pattern was constructed for each encounter by creating edges among functional roles that were captured within the same event log segment. These patterns were classified into groups using graph kernel and unsupervised spectral clustering methods. Demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS) of the groups were compared.Results: Three distinct usage patterns that differed by network density were discovered: fully connected (clique), partially connected, and disconnected (isolated). Compared with the fully connected pattern, encounters with the partially connected pattern had an adjusted median ED LOS that was significantly longer (242.6 [95% confidence interval, 236.9-246.0] minutes vs 295.2 [95% confidence, 289.2-297.8] minutes), more frequently seen among day shift and weekday arrivals, and involved otolaryngology, ophthalmology services, and child life specialists.Discussion: The clique-like usage pattern was associated with decreased ED LOS for the study cohort, suggesting greater degree of collaboration resulted in shorter stay.Conclusions: Further investigation to understand and address causal factors can lead to improvement in multidisciplinary collaboration.