Understanding Variations in CPRS Use Among Primary Care Clinicians

背景/基本原理 退伍军人管理局在实施电子健康记录(EHR)方面一直处于全国领先地位，包括 启用计算机化病历系统(CPRS)的工作站在 流动的检查室。尽管如此，有证据表明CPRS的使用存在很大的变异性 在门诊期间，各个提供者和跨退伍军人管理局的设施。这一变化在 在患者接触之前、期间和之后使用计算机会导致以下问题：如何最好地 将CPR整合到临床工作流程中，以及计算机使用的这种变化如何影响患者- 集中护理。退伍军人的健康结果最终可能会受到 这项技术的实施。例如，在遭遇中CPR使用率较低的情况下， 医生可能不会始终如一地收到所有临床提醒，患者也可能不会收到所有提醒 可能改善其结果的干预措施。 目标 本提案的目的是了解启用CPRS的考试的使用变化 使用或不使用房间计算机如何影响以患者为中心的沟通和临床 门诊初级保健期间的工作流程。我们有两个具体目标： 具体目标1.描述服务提供者在门诊护理期间如何使用CPR的各种变化 在3个退伍军人管理局相遇。 具体目标2.确定将国家方案报告纳入常规工作的障碍和促进者 门诊护理工作流程。 方法 我们提出了一项多地点、多方法的研究，包括两个主要组成部分：1)人种志 观察CPRS在整个门诊护理过程中的使用情况 准备，提供者与患者的面对面接触，以及探视后 文件(目标1)；和2)深入访谈和调查，以确定个人和 设施一级对与CPRS使用相关的障碍和促进者的看法(目标2)。AS 作为人种学观察的一部分，我们将拍摄提供者与患者的接触，这 将使我们能够描述检查室计算机对以患者为中心和 工作流程。 对退伍军人医疗保健的影响 这项研究的结果将帮助我们设计战略，以减少CPRS的使用障碍，并更好地 将CPRS整合到临床工作流程中，以加强对患者的护理。结果将对我们有所帮助 与退伍军人管理局合作，在患者会诊期间优化以患者为中心的理念，并改进 CPRS有效性。医患沟通与患者之间的不解之缘 结果，再加上退伍军人事务部广泛使用CPR，清楚地说明了这一点 研究对于改善退伍军人护理至关重要。

Background/Rationale The VA has been a national leader in electronic health record (EHR) implementation including the availability of Computerized Patient Record System (CPRS) enabled workstations in ambulatory exam rooms. Despite this fact, there is evidence of wide variability in CPRS use by individual providers and across VA facilities during ambulatory encounters. This variation in computer use before, during, and after the patient encounters leads to questions of how best to integrate CPRS into clinical workflow and how this variation in computer use impacts patient- centered care. Veterans' health outcomes may ultimately be compromised by variations in the implementation of this technology. For example, where CPRS use in encounters is low, physicians may not consistently receive all clinical reminders and patients may not receive all interventions that might improve their outcomes. Objectives The objective of this proposal is to understand variations in the use of CPRS- enabled exam room computers and how use or non-use affects patient-centered communication and clinical workflow during outpatient primary care visits. We have two specific aims: Specific Aim 1. Describe variations in how providers employ CPRS during ambulatory care encounters at 3 VA facilities. Specific Aim 2. Identify barriers and facilitators to the integration of CPRS into routine ambulatory care workflow. Methods We propose a multi-site, multi-method study with two main components: 1) ethnographic observations of CPRS use throughout the entire ambulatory care process including pre-visit preparation, the face-to-face encounter between provider and patient, and post-visit documentation (Aim 1); and 2) in-depth interviews and surveys to ascertain individual and facility-level perceptions of barriers and facilitators associated with CPRS usage (Aim 2). As part of the ethnographic observations, we will videotape the provider-patient encounters, which will enable us to describe the impact of exam room computers on patient centeredness and workflow. Impact on Veterans' Healthcare Results from this study will help us design strategies to reduce barriers to CPRS use and better integrate CPRS into clinical workflow in order to enhance patient care. The results will help us work with VA providers to optimize patient-centeredness during patient encounters and improve CPRS effectiveness. The inextricable link between provider-patient communication and patient outcomes, coupled with the widespread use of CPRS in the VA, clearly illustrates that this research is essential to improve veteran care.