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

基本信息

项目摘要

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):广泛建议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。大多数证明电子病历有效性的研究来自四个示范机构,这些机构拥有社区实践环境中不常见的系统级资源和财政、教育和信息技术支持。然而,很少有人知道的有效性,电子病历的护理改善社区门诊设置,在美国提供最初级保健。目的:我们的主要研究问题是:如何在社区为基础的初级保健实践中使用电子病历来照顾病人,以及使用模式如何与医疗保健质量相关?为了解决这个问题,将完成三个目标:目标1:描述如何在广泛的临床护理和非临床活动中普遍使用EMR;目标2:描述如何在急性和慢性护理临床过程中专门使用EMR;目标3:确定指导社区基层医疗实践中使用EMR的策略。方法:本研究采用观察、访谈、问卷调查等多种方法收集资料,并采用质性研究方法。研究参与者将是医生拥有的、使用EMR的单一专业社区初级保健实践的实践成员,并参加了我们的ULTRA研究(N=16)。实践选择将是有目的的和迭代的。将随机选择前两种做法,并将收集深入的定性数据。与此同时,所有参与实践的成员将完成EMR调查。这项调查的数据将为随后的做法选择提供信息。该调查包括关于EMR使用和系统功能的项目,以及评估塑造信息系统使用的人为因素的项目。我们将分析前两种实践的EMR调查响应和定性数据,并将为选择下两种实践提供信息,以进行深入的数据收集和分析。将选择提供最大化变化和学习机会的做法。有目的地选择实践并收集和分析数据以确定EMR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-新病例没有提供与EMR使用相关的新信息。我们预计这将发生在学习8个实践之后。在这一点上,将选择两个额外的做法,以确认/不确认的结果。数据分析:在国家专家的协助下,将使用一系列浸泡/结晶循环进行比较分析,以全面了解EMR的使用和社区初级保健实践中的护理组织。受益:本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流程。调查结果将被用来生成关于有效的EMR使用的假设,在随后的R 01中进行测试的做法之间的代表性样本。这项工作为通过更有效地使用EMR来改善临床护理的干预措施铺平了道路。公共卫生相关性:这项研究将是一个重要的贡献,扩展了目前的知识,如何使用电子病历,以支持临床和非临床护理过程中,以社区为基础的初级保健实践。这项创新研究是通过在这种情况下更有效地使用EMR来改善临床护理的研究计划的第一步。

项目成果

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Deborah Jill Cohen其他文献

Deborah Jill Cohen的其他文献

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{{ truncateString('Deborah Jill Cohen', 18)}}的其他基金

Project Nurture Expansion Study
项目培育扩展研究
  • 批准号:
    10681417
  • 财政年份:
    2021
  • 资助金额:
    $ 23.4万
  • 项目类别:
Project Nurture Expansion Study
项目培育扩展研究
  • 批准号:
    10378325
  • 财政年份:
    2021
  • 资助金额:
    $ 23.4万
  • 项目类别:
Project Nurture Expansion Study
项目培育扩展研究
  • 批准号:
    10493416
  • 财政年份:
    2021
  • 资助金额:
    $ 23.4万
  • 项目类别:
INTEGRATE-D: A pilot-test of implementation strategies to support integration of medical and psychosocial care for people with Type II Diabetes
INTEGRATE-D:支持 II 型糖尿病患者整合医疗和社会心理护理的实施策略试点测试
  • 批准号:
    10089441
  • 财政年份:
    2020
  • 资助金额:
    $ 23.4万
  • 项目类别:
Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES)
评估系统变革以推进学习并扩大证据范围 (ESCALATES)
  • 批准号:
    9267108
  • 财政年份:
    2015
  • 资助金额:
    $ 23.4万
  • 项目类别:
Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES)
评估系统变革以推进学习并扩大证据范围 (ESCALATES)
  • 批准号:
    9060251
  • 财政年份:
    2015
  • 资助金额:
    $ 23.4万
  • 项目类别:
Turning EHRs into Assets for Mental Health and Uniting Practice (Team Up)
将电子病历转化为心理健康资产和联合实践(团队合作)
  • 批准号:
    8495045
  • 财政年份:
    2013
  • 资助金额:
    $ 23.4万
  • 项目类别:
Turning EHRs into Assets for Mental Health and Uniting Practice (Team Up)
将电子病历转化为心理健康资产和联合实践(团队合作)
  • 批准号:
    8838261
  • 财政年份:
    2013
  • 资助金额:
    $ 23.4万
  • 项目类别:
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
  • 财政年份:
    2009
  • 资助金额:
    $ 23.4万
  • 项目类别:

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  • 批准号:
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Targeted interventions to address the multi-level effects of gender-based violence on PrEP uptake and adherence among adolescent girls and young women in Kenya
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