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EHR use and care coordination

EHR 使用和护理协调

基本信息

批准号：
8262141
负责人：
Ilana Graetz
金额：
$ 4.13万
依托单位：
UNIVERSITY OF CALIFORNIA BERKELEY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-01 至 2012-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8262141
关键词：
EHR use care coordination

项目摘要

DESCRIPTION (provided by applicant): While Electronic Health Records (EHR) systems have been consistently promoted as a policy priority for improving the quality and efficiency of the American healthcare system, there is limited research evidence to inform policy-makers about the effects of EHR use on care coordination. This study will use a quasi- experimental design with concurrent controls to evaluate the impact of outpatient physician use of a newly implemented, certified EHR system in Kaiser Permanente Northern California (KPNC) on measures of care coordination, and in turn the association between care coordination and care quality for patients receiving care from multiple clinicians. The study includes all 110 primary care teams in 18 medical centers within the KPNC delivery system, which served over 2 million adult patients (age 18+) between 2005 and 2008. Using multivariate regression analysis, I will examine the association between EHR use and care coordination, while adjusting for clinician characteristics and organizational factors. Additionally, I will examine whether the association between EHR use and care coordination varies by team climate. Finally, I will assess the association between care coordination and clinical care. Measures of care coordination and team climate will be captured using existing self-administered survey responses collected from primary care clinicians in 2005, 2006, and 2008 during the staggered implementation of the EHR system. Quality and clinical outcome measures will be captured using the health system's automated databases and will include guideline-adherent prescription drug use and laboratory monitoring, and physiologic disease control (measured by laboratory tests) for diabetes patients receiving care from multiple clinicians. This study leverages existing data, including survey responses that capture detailed measures of clinician reported care coordination and team climate at multiple points in time as well as the substantial data resources from the study setting. In addition, the staggered nature of the EHR implementation allows for adjustment of secular changes. The 2009 stimulus bill allocated billions of dollars to promote the adoption and meaningful use of EHR. In fact, the definition of meaningful use was specifically designed to target care coordination and care quality. This study will provide important evidence on the role of EHR use on care coordination and quality improvement that are broadly applicable across the nation. In the current clinical environment, where care provided to patients is increasingly fragmented, and also increasingly complex, effective care coordination is essential. Health Information Technology, and specifically EHR, offer new opportunities for improving overall quality of care, preventing medical errors, and reducing health care costs. PUBLIC HEALTH RELEVANCE: The aim of this study is to evaluate the impact of Electronic Health Records (EHR) use on clinician reported measures of care coordination, and in turn the association between care coordination and clinical care for patients with complex care needs. This study will provide important evidence on the role of EHR use on care coordination and quality improvement that are broadly applicable across the nation. In the current clinical environment, where care provided to patients is increasingly fragmented, and also increasingly complex, effective care coordination is essential.

描述（由申请人提供）：虽然电子健康记录 (EHR) 系统一直被宣传为提高美国医疗保健系统质量和效率的政策优先事项，但很少有研究证据可以让政策制定者了解 EHR 使用对护理协调的影响。本研究将使用具有并发控制的准实验设计来评估北加州凯撒医疗机构 (KPNC) 门诊医生使用新实施的经过认证的 EHR 系统对护理协调措施的影响，进而评估接受多名临床医生护理的患者的护理协调与护理质量之间的关联。该研究包括 KPNC 服务系统内 18 个医疗中心的所有 110 个初级保健团队，该系统在 2005 年至 2008 年间为超过 200 万成年患者（18 岁以上）提供服务。我将使用多元回归分析来检查 EHR 使用和护理协调之间的关联，同时调整临床医生特征和组织因素。此外，我将研究 EHR 使用和护理协调之间的关联是否因团队氛围而异。最后，我将评估护理协调与临床护理之间的关联。将使用 2005 年、2006 年和 2008 年 EHR 系统交错实施期间从初级保健临床医生收集的现有自我管理调查答复来捕获护理协调和团队氛围的衡量标准。将使用卫生系统的自动化数据库捕获质量和临床结果测量，并将包括遵守指南的处方药使用和实验室监测，以及接受多名临床医生护理的糖尿病患者的生理疾病控制（通过实验室测试测量）。这项研究利用了现有数据，包括捕捉临床医生报告的护理协调和团队氛围在多个时间点的详细测量的调查回复，以及来自研究环境的大量数据资源。此外，电子病历实施的交错性质允许根据长期变化进行调整。 2009 年的刺激法案拨款数十亿美元来促进 EHR 的采用和有意义的使用。事实上，有意义使用的定义是专门针对护理协调和护理质量而设计的。这项研究将为电子病历的使用在护理协调和质量改进方面的作用提供重要证据，这些证据在全国范围内广泛适用。在当前的临床环境中，为患者提供的护理越来越分散，也越来越复杂，有效的护理协调至关重要。健康信息技术，特别是 EHR，为提高整体护理质量、预防医疗错误和降低医疗保健成本提供了新的机会。公共健康相关性：本研究的目的是评估电子健康记录 (EHR) 的使用对临床医生报告的护理协调措施的影响，进而评估护理协调与具有复杂护理需求的患者的临床护理之间的关联。这项研究将为电子病历的使用在护理协调和质量改进方面的作用提供重要证据，这些证据在全国范围内广泛适用。在当前的临床环境中，为患者提供的护理越来越分散，也越来越复杂，有效的护理协调至关重要。