Discharge Summary Availability and Discontinuity Errors

放电摘要可用性和不连续性错误

• 批准号: 7193414
• 负责人: CARLTON R MOORE
• 金额: $ 12.78万
• 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 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7193414
• 关键词: Discharge; Summary; Availability; Discontinuity; Errors

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（由申请方提供）：医学研究所报告《人皆有错》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并不包括在内。因急性疾病住院的病人出院后往往服用新的药物，检查结果仍在等待中，亚急性疾病需要解决，但不值得进一步住院。未能跟进这些未解决的医疗问题可能会导致不良结果，因为延误诊断和治疗。传统上，出院小结是住院医生向门诊医生传达这一信息的手段。然而，传达这些信息的系统往往是次优的，只有不到一半的门诊初级保健医生（PCP）收到过他们病人的出院摘要。由于住院患者与门诊患者之间关于患者出院计划的沟通不良而导致的中断错误（用药连续性错误、检查随访错误和检查错误）的发生率可能高达50%。 本研究的具体目的是：1）进行一次全国性的医院调查，以确定目前用于传达出院信息的系统及其感知的有效性; 2）利用自然实验进行中断时间序列队列研究，以测量和比较网络实施前后住院后发生的不连续性错误的频率。基于系统向门诊PCP传播出院总结; 3）评估不连续性错误之间的关联（用药连续性错误、检查随访错误和检查错误）和不良事件（再入院、艾德访视和紧急访视）;设计并评估一项随机对照试验，以比较电子邮件（主动）策略与基于网络（被动）策略的有效性传播电子出院摘要的策略，以降低不连续性错误和不良事件的发生率。