An Automatic Notification System for Test Results Finalized after Discharge

描述(由申请人提供)：摘要：出院后过渡到门诊环境对患者来说是一个脆弱的时期。一个重要的患者安全问题是，负责任的提供者未能可靠地跟踪患者出院后最终确定的测试结果。这种失败可能导致诊断延误、错过治疗机会、多余的检查顺序，以及随后的患者伤害。确保将这些检测结果及时通知给负责任的提供者的自动化系统有可能缓解这些有充分记录的问题，并提高医疗保健质量和安全。该项目的目标是创建一个基于信息技术的自动通知系统，以提醒负责任的医生出院后最终确定的测试结果，并评估该系统对医生了解这些测试结果的影响。在这项研究的第一阶段，将设计系统的组件。这些包括1)查询在出院时其最终结果悬而未决的所有测试，2)查询身份和电子邮件 患者负责任的住院患者和门诊提供者的地址；3)排除常规的住院患者检查以避免提供者警觉疲劳的逻辑；4)一旦最终的检查结果可用，自动通过电子邮件通知给负责任的提供者；以及5)将这些结果记录在门诊电子医疗记录中。该系统旨在促进患者过渡到门诊环境期间住院和门诊提供者之间的及时沟通和创建协作护理计划。将进行一项整群随机对照试验，以衡量这种系统对医生意识的影响。为了最大限度地减少污染，住院医生和门诊医生都将被随机分配，只有在两名负责任的医生都在研究的同一分支时，患者才会被纳入研究。研究对象将包括从布里格姆妇女医院住院的普通内科和心脏病服务出院的患者。主要结果将是负责任的提供者了解所有出院后测试结果。次要结果将包括用户满意度、对可操作测试结果的认识(由提供者判断)，以及随后是否针对这些结果采取适当的行动(基于电子病历审查)。医生的意识将在第一个最终测试结果出来72小时后通过向提供者发送电子邮件调查来确定。主要结果将根据提供者知道的每个患者的检测结果的比例使用二项逻辑分析进行分析 回归。一般估计方程将用于根据患者和医生的特征进行调整，并按医生分类。在为期六个月的研究期间，将招募450名患者，以便提供足够的能量来检测结果的40%到60%的意识改善。这项研究的结果将为未来在BWH和其他试图解决这一重要患者安全问题的机构优化此类干预措施的努力提供参考。

DESCRIPTION (provided by applicant): Abstract: The transition to the ambulatory setting following hospital discharge is a vulnerable time for patients. One important patient safety concern is failure of responsible providers to reliably follow up test results finalized after a patient is discharged. Such failure can lead to delays in diagnosis, missed treatment opportunities, redundant ordering of tests, and subsequent patient harm. Automated systems that ensure timely notification of these test results to responsible providers have the potential to mitigate these well documented problems and improve health care quality and safety. The goals of this project are to create an information technology-based automatic notification system to prompt responsible physicians of test results finalized after discharge and to evaluate the impact of this system on physician awareness of these test results. In the first phase of this study, the components of the system will be designed. These include 1) a query of all tests whose final results are pending at the time of discharge, 2) a query for the identity and email addresses of the patient's responsible inpatient and ambulatory provider, 3) logic to exclude routinely ordered inpatient tests to avoid provider alert fatigue, 4) automatic email notification of finalized test results to responsible providers once they are available, and 5) documentation of these results in the ambulatory electronic medical record. The system is designed to facilitate timely communication and the creation of a collaborative plan of care among inpatient and outpatient providers during a patient's transition to the ambulatory setting. A cluster randomized controlled trial will be conducted to measure the impact of such a system on physician awareness. To minimize contamination, both inpatient and ambulatory providers will be randomized, and patients will only be enrolled if both responsible physicians are in the same arm of the study. Study subjects will include patients discharged from the inpatient general medicine and cardiology services at Brigham and Women's Hospital. The primary outcome will be awareness of all post-discharge test results among responsible providers. Secondary outcomes will include user satisfaction, awareness of actionable test results (as judged by providers), and whether appropriate actions are subsequently taken in response to these results (based on electronic medical record review). Physician awareness will be determined using an email survey to providers 72 hours after the first finalized test result is available. The primary outcome will be analyzed as the proportion of test results per patient of which a provider is aware using binomial logistic regression. General estimating equations will be used to adjust for patient and physician characteristics and to cluster by physician. Over a six-month study period, 450 patients will be enrolled in order to provide adequate power to detect an improvement in awareness from 40% to 60% of results. The results of this study will inform future efforts to optimize this type of intervention both at BWH and at other institutions trying to solve this important patient safety problem.