Cardiovascular Disease Care and EMR Use in Community-based Primary Care Practices

心血管疾病护理和 EMR 在社区初级保健实践中的使用

• 批准号: 7917184
• 负责人: Deborah Jill Cohen
• 金额: $ 19.5万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-15 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7917184
• 关键词: Acute; Address; Adherence; Cardiovascular Diseases; Caring; Chronic; Chronic Care; Clinical; Clinical Management; Collection; Communities; Community Practice; Computerized Medical Record; Crystallization; Data; Data Analyses; Data Collection; Diabetes Mellitus; Drug Formulations; Effectiveness; Financial Support; Guidelines; Human; Hyperlipidemia; Hypertension; Immersion Investigative Technique; Information Systems; Information Technology; Institution; Intervention; Interview; Investigation; Knowledge; Learning; Methods; New Jersey; Outcome; Paper; Participant; Patient Care; Pattern; Pennsylvania; Physicians; Primary Health Care; Process; Qualitative Research; Quality of Care; Research; Research Methodology; Resources; Safety; Sampling; Series; Shapes; Site; Smoking; Source; Surveys; System; Testing; Time; United States; Upper Respiratory Infections; Variant; Work; base; clinical care; comparative; health care quality; improved; innovation; insight; medical specialties; member; primary care setting; programs; public health relevance; response; tool

DESCRIPTION (provided by applicant): The use of electronic medical records (EMRs) in ambulatory settings is widely recommended to improve the safety, quality and efficiency of patient care. Most research demonstrating the efficacy of EMRs comes from four exemplar institutions that have system level resources and support for financial, educational and information technology not commonly available in community practice settings. Less, however, is known about the effectiveness of EMRs for care improvement in community ambulatory settings where most primary care in the United States is delivered. Objective: Our principal research question is: How are EMRs used among community-based primary care practices to care for patients and how are use patterns related to health care quality? To address this question, three aims will be accomplished: Aim 1: To describe how EMRs are generally used in a broad range of clinical care and non-clinical activities; Aim 2: To describe how EMRs are specifically used in acute and chronic care clinical processes; and Aim 3: To identify strategies that guide EMR use in community-based primary care practices. Methods: This study involves collection of multi-method data (observation, interview, survey) and employs a qualitative research methodology. Study participants will be practice members at physician-owned, single specialty community primary care practices that use an EMR and participated in our ULTRA study (N=16). Practice selection will be purposeful and iterative. The first two practices will be randomly selected, and in depth qualitative data will be collected. At the same time, an EMR survey will be completed by members of all participating practices. Data from this survey will inform subsequent practice selection. The survey includes items about EMR use and system functionality, and items to evaluate human factors that shape information system use. EMR survey responses and qualitative data from the first two practices will be analyzed, and insights will inform the selection of the next two practices for in depth data collection and analysis. Practices will be selected that offer the opportunity to maximize variation and learning. The iterative process of purposefully selecting practices and collecting and analyzing data to identify the important determinants of EMR use will continue until saturation is reached - the point at which new cases provide no new information related to EMR use. We anticipate this will occur after studying 8 practices. At this point, two additional practices will be selected to confirm/disconfirm findings. Data Analysis: With the assistance of national experts, a comparative analysis will be conducted using a series of immersion/crystallization cycles to develop a comprehensive understanding of EMR use and the organization of care in community primary care practice. Benefits: This study will identify how community primary care practices use EMRs to support clinical and non-clinical care processes. Findings will be used to generate hypotheses about effective EMR use to be tested in a subsequent R01 among a representative sample of practices. This work paves the way for interventions to improve clinical care through more effective EMR use. Public Health Relevance: This study will be an important contribution, extending current knowledge of how EMRs are used to support clinical and non-clinical care processes in community-based primary care practices. This innovative study is the first step in a program of research to improve clinical care through more effective EMR use in this setting.

描述(由申请人提供)：广泛推荐在门诊环境中使用电子病历(EMR)，以提高患者护理的安全性、质量和效率。证明EMR有效性的大多数研究来自四个示范机构，这些机构拥有系统一级的资源，并为社区实践环境中常见的财务、教育和信息技术提供支持。然而，人们对急诊室在社区门诊环境中改善护理的有效性知之甚少，在美国，大多数初级保健都是在社区门诊环境中提供的。目的：我们的主要研究问题是：在以社区为基础的初级保健实践中，急诊室如何用于患者护理，使用模式与卫生保健质量如何相关？为了解决这个问题，将实现三个目标：目标1：描述急诊护理和非临床活动一般如何使用急诊护理；目标2：描述急慢性护理临床流程中如何具体使用急诊和慢性护理；以及目标3：确定指导社区初级保健实践中使用急诊护理的战略。方法：本研究采用多方法资料收集(观察法、访谈法、调查法)，采用质的研究方法。研究参与者将是医生拥有的、使用EMR的单一专科社区初级保健诊所的执业成员，并参与了我们的ULTRA研究(N=16)。实践选择将是有目的的和迭代的。前两个实践将被随机选择，并将深入收集定性数据。同时，所有参与实践的成员将完成EMR调查。本次调查的数据将为后续的实践选择提供依据。该调查包括有关电子病历使用和系统功能的项目，以及评估影响信息系统使用的人为因素的项目。将分析EMR调查答复和来自前两个实践的定性数据，洞察力将为选择下两个实践进行深入数据收集和分析提供依据。将选择提供机会最大限度地进行变化和学习的实践。有目的地选择做法以及收集和分析数据以确定电子病历使用的重要决定因素的迭代过程将继续下去，直到达到饱和--即新病例不提供与电子病历使用有关的新信息。我们预计，在研究了8个实践之后，这将会发生。在这一点上，将选择另外两个实践来确认/不确认调查结果。数据分析：在国家专家的协助下，将使用一系列浸入/结晶循环进行比较分析，以全面了解EMR在社区初级保健实践中的使用和护理的组织。好处：这项研究将确定社区初级保健实践如何使用EMR来支持临床和非临床护理过程。研究结果将被用来生成关于有效使用电子病历的假设，并在随后的R01中对具有代表性的实践样本进行测试。这项工作为通过更有效地使用EMR来改善临床护理的干预铺平了道路。公共卫生相关性：这项研究将是一项重要的贡献，扩大了关于急诊医生如何在社区初级保健实践中用于支持临床和非临床护理过程的现有知识。这项创新研究是通过在这种环境下更有效地使用EMR来改善临床护理的研究计划的第一步。