COMPUTER BASED DOCUMENTATION AND PROVIDER INTERACTION

点击翻译按钮获取中文摘要

Programs for on-line documentation have become a popular addition to computer-based patient records. Most of these tools use personal computers and on-screen forms to construct a patient visit note. In a pediatric primary care or family practice setting, these programs potentially can improve compliance with age-appropriate screening, developmental testing, and immunization delivery guidelines. The computer also may remind the provider about issues to address and will help ensure complete documentation. However, computer-based documentation (CBD) may distract the provider, the patient, or the parent. Computers might cause parents to feel distanced from providers who focus attention on the computer to enter data. Computers might result in more time being spent completing documentation. Unfortunately, there are no controlled studies that have evaluated the effect of CBD on the quality of the health- maintenance encounter in a primary care practice setting. The aim of this project is to evaluate how using online documentation tools based on age-specific encounter guidelines for pediatric health-maintenance visits affects the quality of the encounter, as measured by the number of psychosocial and anticipatory guidance issues addressed during a visit, the parent and provider satisfaction with the encounter, and the duration of the encounter. These results will be evaluated with respect to different patterns of documenting the encounter (during the visit, after the visit, at the end of the clinic session.) The study utilizes a pre and post intervention design. The control group consists of encounters with families seen before the implementation of CBD. The intervention group consists of encounters that occurred two years later-1 year after the implementation of CBD. The study includes children under the age of 18 months, being seen for "well-child care." Each encounter is audiotaped. At the conclusion of the encounter, both the provider and the family are asked to complete an exit survey that assesses their satisfaction with the encounter. Providers also are asked to describe how they used CBD during this visit, and to assess how useful the electronic template was for this patient encounter. Data about the encounter's content and the provider's communication style will be obtained through an analysis of the audiotapes using a tool called the Roter Interactional Analysis System, which provides a reliable and valid analysis of patient, provider, computer interaction. Patient and provider satisfaction data will be derived from analysis of the exit survey.