A randomized, controlled trial of clinical information shared from another institution
A randomized, controlled trial of clinical information shared from another institution
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DOI：
10.1067/mem.2002.120794
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发表时间：
2002-01-01
影响因子：
6.2
通讯作者：
McDonald, CJ
中科院分区：
文献类型：
--
作者：
Overhage, JM;Dexter, PR;McDonald, CJ
研究目的：急诊医生通常必须以最少的机会获得历史临床信息来提供医疗服务。我们论证了在患者在急诊科接受治疗期间增加从另一家医院获取患者临床信息的可行性和潜在价值。方法：我们进行了一项试点随机对照试验，从一家城市医院的大型、纵向、基于计算机的临床数据记录系统向位于两个城市急诊室之一的急诊医生提供信息。我们将在急诊室就诊的患者随机分为两组，一组将电脑病历系统中的信息提供给他们的医生，另一组不提供信息。提供给急诊医生作为打印摘要和通过在线访问基于计算机的患者记录。我们评估了费用、入院次数、急诊重复就诊以及急诊医生对信息的满意度。结果：在某些假设下，干预措施估计在一家医院每次就诊急诊费用减少约26美元(P=0.03)，但对另一家医院的费用没有影响。这一结果可能是因为这两个急诊室在工作流程和信息获取方面的显着差异，我们证明入院率或重复到急诊室就诊没有差异。急诊医生发现，记住他们的密码和搜索信息所需的时间是在线获取临床信息的重要障碍。结论：我们的试点研究首次证明了不同医疗保健系统之间共享临床信息的可行性。我们观察到2家医院中有1家有节省成本的趋势，我们研究的质量指标没有差异。我们的经验显示，要研究全民健康护理干预措施对急症室护理服务成本和质素的影响，所遇到的困难是很大的。
Study objective: Emergency physicians often must deliver medical care with minimal access to historical clinical information. We demonstrate the feasibility and potential value of increased access to patients' clinical information from another hospital while they are receiving care in the emergency department.Methods: We conducted a pilot randomized, controlled trial of providing information from a large, longitudinal, computer-based patient record system of clinical data from an urban hospital to emergency physicians at either of 2 urban EDs. We randomized patients seen at either ED to have the information from the computer-based patient record system provided to their physician or to not have the information provided We delivered information. to the emergency physician both as a printed abstract and by means of online access to the computer-based patient record. We assessed charges, hospital admissions, repeat visits to EDs, and the emergency physicians' satisfaction with the information.Results: Under certain assumptions, the intervention was estimated to decrease charges for ED care by approximately $26 per encounter (P = .03) at 1 hospital but there was no effect on, charges at the other hospital. This result was likely because of marked differences in the workflows and information access at these 2 EDs We demonstrated no differences in admission rates or repeat visits to the ED. Emergency physicians identified that remembering their passwords and the time required to search for the information were significant barriers to accessing clinical information online.Conclusion: Our pilot study is the first to demonstrate the feasibility of sharing clinical information between different health care systems. We observed a trend toward cost savings at 1 of 2 hospitals and no differences in the quality measures we studied. Our experience underscores the difficulties inherent in studying the effects of community-wide health care interventions on cost and quality of ED care.