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)：医学研究所向Err is Human提交的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整体程度，因为出院后发生的伤害不包括在内。因急性疾病住院的患者通常会服用新药出院，测试结果仍未公布，亚急性医疗问题需要解决，但不值得进一步住院。如果不对这些悬而未决的医疗问题采取后续行动，可能会因为延误诊断和治疗而导致不良结局。传统上，医院出院摘要是将这些信息从住院患者传达给门诊医生的手段。然而，传达这一信息的系统往往不是最优的，所有门诊初级保健医生(PCP)中只有不到一半的人收到过患者的出院摘要。由于患者出院计划的住院患者与门诊患者沟通不畅而导致的间断错误(用药连续性错误、测试跟踪错误和工作错误)的发生率可能高达50%。 这项研究的具体目的是：1)对医院进行具有全国代表性的调查，以确定当前用于传达医院出院信息的系统及其感知的疗效；2)利用自然实验进行中断的时间序列队列研究，以测量和比较在实施基于网络的系统向门诊PCP分发出院摘要之前和之后住院后发生的中断错误的频率；3)评估该队列中的中断错误(药物连续性错误、测试跟踪错误和检查错误)与不良事件(重新入院、急诊室就诊和紧急就诊)之间的关系；4)设计和评价一项随机对照试验，比较电子邮件(主动)策略和基于网络(被动)策略传播电子医院出院摘要在降低间断差错和不良事件发生率方面的有效性。