Virtual Continuity and its Impact on Complex Hospitalized Patients' Care

描述(由申请人提供)：护理住院患者的医生与这些患者的初级保健提供者(PCP)之间的沟通通常是次优的。以医院为基础的信息系统可以通过自动化医院医生和初级保健医生之间的信息交换来改善沟通，并可能因此提高卫生保健的质量和安全。匹兹堡大学医学中心(UPMC)的电子医生交流工具MedTrak已被证明是成功的，并准备推进一项我们称为虚拟连续性的倡议，允许PCP在无法实际跟踪患者的情况下通过电子方式跟踪他们的患者。虚拟连续性将包括：由临床事件触发的发给PCP的电子邮件，其中嵌入了指向电子病历数据的链接 和通信门户，入院和出院时以电子方式发送给初级保健医生的药物清单，以及即时初级保健医生出院通知和相关的临床细节。 为了评估虚拟连续性，我们将使用虚拟连续性与常规沟通相比较的整群随机研究设计，检查复杂内科患者出院用药错误的频率。将使用公认的方法来确定用药错误。我们还将调查再住院、出院后急诊科就诊和PCP随访率的差异，以及患者和PCP对医院沟通的满意度。还将评估实施和维持虚拟连续性干预的信息技术费用。 虚拟连续性将使初级保健医生能够更直接地参与其住院病人的护理。改善沟通可以为有复杂医疗问题的住院患者带来更高质量的患者护理和更大的患者护理安全。

DESCRIPTION (provided by applicant): Communication between physicians caring for hospitalized patients and those patients' primary care providers (PCPs) is often suboptimal. Hospital-based information systems can improve communication by automating information exchange between hospital physicians and PCPs, and perhaps, as a result, improve the quality and safety of health care. MedTrak, the University of Pittsburgh Medical Center (UPMC) electronic physician communication tool, has proven successful and is poised to move forward with an initiative we call virtual continuity, allowing PCPs to follow their patients electronically if they cannot do so physically. Virtual continuity will include: emails to PCPs triggered by clinical events with embedded links to electronic medical record data and communication portals, medication lists electronically delivered to PCPs at admission and discharge, and immediate PCP notification of discharge with pertinent clinical details. To evaluate virtual continuity, we will examine the frequency of discharge medication errors in complex medical patients using a cluster randomized study design of virtual continuity compared to usual communication. Medication errors will be ascertained using accepted methods. We will also investigate differences in rehospitalization, post discharge emergency department visit and PCP follow up rates, as well as patient and PCP satisfaction with hospital communication. The IT cost of implementing and maintaining the virtual continuity intervention will also be assessed. Virtual continuity will allow PCPs to participate more directly in the care of their hospitalized patients. Improved communication could lead to higher-quality patient care and greater patient care safety for hospitalized patients with complex medical problems.