The Benefit and Burden of Electronic Reminders for Optimizing Patient Care

电子提醒优化患者护理的好处和负担

• 批准号: 8799294
• 负责人: David Chimin Chan
• 金额: $ 35万
• 依托单位: PALO ALTO VETERANS INSTIT FOR RESEARCH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-12 至 2019-08-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8799294
• 关键词: Administrator; Adopted; Affect; Area; Attention; Behavioral; Caring; Characteristics; Clinical; Cognitive; Complex; Data; Diabetes Mellitus; Dimensions; Disease Management; Dose; Electronics; Environment; Evaluation; Glycosylated hemoglobin A; Goals; Health; Healthcare Systems; Human; Informatics; Information Systems; Investments; Knowledge; Laboratories; Measures; Methods; Mission; Natural experiment; Patient Care; Patients; Physicians; Preventive; Primary Health Care; Process; Provider; Psychology; Public Health; Reminder Systems; Research; Research Personnel; Resources; Screening for cancer; Surveys; System; Testing; Time; Training; Variant; Veterans; caregiving; clinical care; design; experience; health administration; health care service organization; health information technology; improved; innovation; public health relevance; response

DESCRIPTION (provided by applicant): One of the central innovations of the health information technology (HIT) revolution is the use of electronic reminders to provide clinicians with potentially relevant information to support clinical decisions. On the one hand, electronic reminders can present helpful information to support better patient care. On the other hand, given the limits of human cognitive processing and attention, there is the distinct possibility tha reminders may overburden clinicians with too much information. There is currently little empirical evidence weighing the benefits and burdens of increasing the informational content of systems of electronic reminders. Without a better understanding of how varying the information presented in systems of HIT affects patient care, it will not be possible to build HIT systems - an enterprise with $35 billion in annual investments - to optimize patient care. The long-term goal is to develop empirical methods using data from real health care systems to identify the effect of important design margins of HIT systems on actual patient care and health. The objective in this particular application is to quantitatively measure key characteristics of variation in electronic reminder systems in 130 health care systems within the Veterans Health Administration (VHA) and then to use these measures to estimate the effect of increasing the informational content of a system of reminders on the quality of primary care delivered. Preliminary data using counts of informational items associated with reminders suggest wide variation across systems of reminders. The same provider caring for the same patient may be required to process 5 or 40 reminder-related pieces of information on preventive care and disease management, depending on the health care system and time. I will achieve this objective by pursuing three specific aims: (1) Quantify differences in sets of electronic reminders across VHA health care systems over time. In addition to preliminary evidence using counts of informational items, I will quantitativel measure other dimensions of variation (e.g., topic breadth, complexity, and comprehensibility) in the informational content of systems of reminders. (2) Estimate the dose response of primary care quality measures to the informational content of reminders, using natural experiments on the set of reminders presented to clinicians. (3) Determine how the dose response to the informational content of reminders depends on patient, provider, and organizational context. Using administrative patient- and provider-level data, external data on provider board scores, and surveys at the organizational level, I will examine how the response to reminders differs across contexts described by these characteristics. The approach is innovative in its use of detailed administrative data, variation in the content of information presented in HIT systems, and natural experiments changing this information content. The proposed research is significant because it represents a first step towards defining the "right amount" of information in HIT to optimize patient care, given provider cognitive limitations. Progress in this area is needed to enable the evaluation and design of HIT systems to optimize patient care.

描述（由申请人提供）：健康信息技术（HIT）革命的核心创新之一是使用电子提醒为临床医生提供潜在相关信息，以支持临床决策。一方面，电子提醒可以提供有用的信息，以支持更好的患者护理。另一方面，考虑到人类认知处理和注意力的局限性，提醒可能会让临床医生负担太多的信息。目前几乎没有经验证据来衡量增加电子提醒系统的信息内容的好处和负担。如果不更好地理解HIT系统中呈现的信息变化如何影响患者护理，就不可能构建HIT系统， 该公司每年投资350亿美元，用于优化患者护理。长期目标是 使用来自真实的医疗保健系统的数据开发经验方法，以确定HIT系统的重要设计裕度对实际患者护理和健康的影响。在这个特定的应用程序中的目标是定量测量的变化在130个医疗保健系统内的退伍军人健康管理局（VHA）的电子提醒系统的关键特性，然后使用这些措施来估计的效果，增加的信息内容的系统的提醒提供的初级保健的质量。使用与提醒相关的信息项计数的初步数据表明，提醒系统之间存在很大差异。根据医疗保健系统和时间的不同，同一个提供者照顾同一个病人可能需要处理5或40条与预防保健和疾病管理有关的信息。我将通过追求三个具体目标来实现这一目标：（1）随着时间的推移，量化VHA医疗保健系统中电子提醒的差异。除了使用信息项计数的初步证据外，我还将定量测量变异的其他维度（例如，主题广度、复杂性和可理解性）。(2)估计初级保健质量措施的剂量反应的信息内容的提醒，使用自然实验的提醒给临床医生。(3)确定剂量对提醒信息内容的反应如何取决于患者、提供者和组织背景。使用管理患者和供应商级别的数据，供应商董事会分数的外部数据，并在组织层面的调查，我将研究如何响应提醒不同的上下文所描述的这些特征。该方法是创新的，在其使用的详细的行政数据，变化的内容中提出的信息在HIT系统，和自然实验改变这一信息内容。拟议的研究是重要的，因为它代表了第一步，以定义“适量”的信息，在HIT，以优化病人护理，提供者的认知限制。需要在这一领域取得进展，以使HIT系统的评估和设计，以优化病人护理。