Tackling Ambulatory Safety Risks Through Patient Engagement: What 10,000 Patients and Families Say About Safety-Related Knowledge, Behaviors, and Attitudes After Reading Visit Notes
Tackling Ambulatory Safety Risks Through Patient Engagement: What 10,000 Patients and Families Say About Safety-Related Knowledge, Behaviors, and Attitudes After Reading Visit Notes
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DOI：
10.1097/pts.0000000000000494
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发表时间：
2021-12-01
影响因子：
2.2
通讯作者：
Bourgeois, Fabienne
中科院分区：
文献类型：
--
作者：
Bell, Sigall K.;Folcarelli, Patricia;Bourgeois, Fabienne
临床医生很难发现门诊安全风险，包括延迟诊断或遗漏异常检查结果，因为它们通常发生在两次就诊之间。专家们主张加强患者参与以提高安全性，但策略有限。患者访问临床记录（“OpenNotes”）可能有助于缩小访视之间的安全差距。方法我们调查了2016年6月至9月期间在两家学术医院登录患者门户网站并在过去12个月内至少有一个动态笔记的患者和家属，重点关注患者报告的OpenNotes对安全知识，行为和态度的影响。结果成人医院的24,722名患者中有6913名（28%）和儿童医院的21,579名参与者中有3672名（17%）提交了调查。大约75%的患者和父母都报告说，阅读笔记帮助他们理解了测试和转诊的原因，大约50%的人认为它帮助他们完成测试和转诊。大约75%的参与者更有可能检查和理解测试结果。总体而言，97%的参与者报告说，在阅读1个或更多的笔记后，对提供者的信任、激活、患者-提供者目标对准和团队合作都更好或相同。与白色和受教育程度更高的受访者相比，非白人参与者和高中或更低学历的参与者分别有30%至50%的可能性报告阅读笔记有助于他们完成测试。总的来说，超过10，000名患者和家长中的大多数报告了阅读笔记有助于他们理解和跟进测试和转诊。随着信息透明度的普及，OpenNotes可以帮助激活患者和家庭，促进安全行为，并与临床医生建立更强大的合作伙伴关系。
Background Ambulatory safety risks including delayed diagnoses or missed abnormal test results are difficult for clinicians to see, because they often occur in the space between visits. Experts advocate greater patient engagement to improve safety, but strategies are limited. Patient access to clinical notes ("OpenNotes") may help close the safety gap between visits. Methods We surveyed patients and families who logged on to the patient portal and had at least one ambulatory note available in the past 12 months at two academic hospitals during June to September 2016, focusing on patient-reported effects of OpenNotes on safety knowledge, behaviors, and attitudes. Results A total of 6913 (28%) of 24,722 patients at an adult hospital and 3672 (17%) of 21,579 participants at the children's hospital submitted surveys. Approximately 75% of patients and parents each reported that reading notes helped them understand the reason for both tests and referrals, and approximately 50% felt that it helped them complete tests and referrals. Roughly 75% of participants were more likely to check and understand test results. Overall, 97% of participants reported that trust in the provider, activation, patient-provider goal alignment, and teamwork were each better or the same after reading 1 note or more. Nonwhite participants and those with high school education or less were 30% to 50% more likely to report that reading notes helped them complete tests compared with white and more educated respondents, respectively. Conclusions Overall, the majority of more than 10,000 patients and parents reported reading notes helped them understand and follow through on tests and referrals. As information transparency spreads, OpenNotes can help activate patients and families, facilitate safety behaviors, and forge stronger partnerships with clinicians.