Discharge Summary Availability and Discontinuity Errors

放电摘要可用性和不连续性错误

• 批准号: 6823985
• 负责人: CARLTON R MOORE
• 金额: $ 12.77万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-03-02 至 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6823985
• 关键词: Internet; behavioral /social science research tag; clinical research; communication; comprehensive care; computer assisted patient care; computer system design /evaluation; health care service evaluation; health care service utilization; health services research tag; health surveys; hospital analysis; hospital organization /administration; hospital patient care; human data; information dissemination; longitudinal human study; medical records; outcomes research; outpatient care; patient oriented research; patient safety /medical error; telecommunications

DESCRIPTION (provided by the applicant): The incidence of adverse events in the Institute of Medicine's report To Err is Human may underestimate the overall extent of the patient safety problem in the U.S., since injuries occurring after discharge from the hospital were not included. Patients hospitalized for acute medical conditions are often discharged on new medications, with test results that are still pending and with sub-acute medical problems that need to be addressed, but who do not merit further hospitalization. Failure to follow-up on these unresolved medical issues may result in poor outcomes because of delays in diagnosis and treatment. The hospital discharge summary has traditionally been the means through which this information is communicated from the inpatient to the outpatient physician. However, the systems to communicate this information are often sub-optimal, and less than half of all outpatient primary care physicians (PCPs) ever receive their patients' hospital discharge summaries. Discontinuity errors (medication continuity errors, test follow-up errors, and work-up errors) resulting from poor inpatient-to-outpatient communication about patients' discharge plans may occur as often as 50% of the time. The specific aims of the study are to: 1) Conduct a nationally representative survey of hospitals to identify the current systems used to communicate hospital discharge information and their perceived efficacy; 2) Take advantage of a natural experiment to perform an interrupted time series cohort study to measure and compare the frequency of discontinuity errors that occur after hospitalization before and after implementation of a web-based system to disseminate discharge summaries to outpatient PCPs; 3) Assess associations between discontinuity errors (medication continuity errors, test follow-up errors, and work-up errors) and adverse events (readmissions, ED visits, and urgent visits) in this cohort; and 4) Design and evaluate a randomized-controlled trial to compare the effectiveness of an e-mail (active) strategy versus a web-based (passive) strategy of disseminating electronic hospital discharge summaries for reducing rates of discontinuity errors and adverse events.

描述（由申请人提供）：医学研究所报告中的不良事件发生率可能低估了美国患者安全问题的总体程度，因为出院后发生的伤害未包括在内。因急性病住院的病人出院时往往服用了新的药物，但检查结果尚未公布，而亚急性的医疗问题需要解决，但不值得进一步住院治疗。未能对这些未解决的医疗问题采取后续行动，可能会由于诊断和治疗的延误而导致不良结果。出院摘要传统上是住院病人向门诊医生传达这些信息的手段。然而，沟通这些信息的系统往往不是最优的，不到一半的门诊初级保健医生（pcp）曾经收到过病人的出院摘要。由于住院与门诊之间关于患者出院计划的沟通不佳而导致的不连续错误（药物连续性错误、测试随访错误和检查错误）的发生率可能高达50%。