EHR use and care coordination

描述（由申请人提供）：虽然电子健康记录（EHR）系统一直被视为提高美国医疗保健系统质量和效率的政策优先事项，但关于使用EHR对护理协调的影响，政策制定者的研究证据有限。本研究将采用并行对照的准实验设计来评估门诊医生使用Kaiser Permanente北加州（KPNC）新实施的认证电子病历系统对护理协调措施的影响，以及接受多名临床医生护理的患者的护理协调与护理质量之间的关系。该研究包括KPNC交付系统内18个医疗中心的所有110个初级保健团队，这些团队在2005年至2008年期间为200多万成年患者（18岁以上）提供服务。使用多元回归分析，我将检验电子病历使用与护理协调之间的关系，同时调整临床医生特征和组织因素。此外，我将检查电子病历使用和护理协调之间的关系是否因团队氛围而异。最后，我将评估护理协调与临床护理之间的关系。将利用2005年、2006年和2008年在错开实施电子健康档案系统期间从初级保健临床医生收集的现有的自我管理调查反馈，捕捉护理协调和团队氛围的措施。将使用卫生系统的自动化数据库捕获质量和临床结果测量，并将包括遵循指南的处方药使用和实验室监测，以及接受多名临床医生治疗的糖尿病患者的生理疾病控制（通过实验室测试测量）。本研究利用了现有的数据，包括调查反馈，这些反馈捕获了临床医生报告的多个时间点的护理协调和团队气氛的详细测量，以及来自研究环境的大量数据资源。此外，EHR实施的交错性质允许对长期变化进行调整。2009年的经济刺激法案拨款数十亿美元来促进电子病历的采用和有效使用。事实上，有意义使用的定义是专门针对护理协调和护理质量而设计的。本研究将为电子病历在全国范围内广泛适用的护理协调和质量改善中的作用提供重要证据。在目前的临床环境中，向患者提供的护理越来越分散，也越来越复杂，有效的护理协调至关重要。卫生信息技术，特别是电子病历，为提高整体护理质量、预防医疗差错和降低卫生保健成本提供了新的机会。

DESCRIPTION (provided by applicant): While Electronic Health Records (EHR) systems have been consistently promoted as a policy priority for improving the quality and efficiency of the American healthcare system, there is limited research evidence to inform policy-makers about the effects of EHR use on care coordination. This study will use a quasi- experimental design with concurrent controls to evaluate the impact of outpatient physician use of a newly implemented, certified EHR system in Kaiser Permanente Northern California (KPNC) on measures of care coordination, and in turn the association between care coordination and care quality for patients receiving care from multiple clinicians. The study includes all 110 primary care teams in 18 medical centers within the KPNC delivery system, which served over 2 million adult patients (age 18+) between 2005 and 2008. Using multivariate regression analysis, I will examine the association between EHR use and care coordination, while adjusting for clinician characteristics and organizational factors. Additionally, I will examine whether the association between EHR use and care coordination varies by team climate. Finally, I will assess the association between care coordination and clinical care. Measures of care coordination and team climate will be captured using existing self-administered survey responses collected from primary care clinicians in 2005, 2006, and 2008 during the staggered implementation of the EHR system. Quality and clinical outcome measures will be captured using the health system's automated databases and will include guideline-adherent prescription drug use and laboratory monitoring, and physiologic disease control (measured by laboratory tests) for diabetes patients receiving care from multiple clinicians. This study leverages existing data, including survey responses that capture detailed measures of clinician reported care coordination and team climate at multiple points in time as well as the substantial data resources from the study setting. In addition, the staggered nature of the EHR implementation allows for adjustment of secular changes. The 2009 stimulus bill allocated billions of dollars to promote the adoption and meaningful use of EHR. In fact, the definition of meaningful use was specifically designed to target care coordination and care quality. This study will provide important evidence on the role of EHR use on care coordination and quality improvement that are broadly applicable across the nation. In the current clinical environment, where care provided to patients is increasingly fragmented, and also increasingly complex, effective care coordination is essential. Health Information Technology, and specifically EHR, offer new opportunities for improving overall quality of care, preventing medical errors, and reducing health care costs. PUBLIC HEALTH RELEVANCE: The aim of this study is to evaluate the impact of Electronic Health Records (EHR) use on clinician reported measures of care coordination, and in turn the association between care coordination and clinical care for patients with complex care needs. This study will provide important evidence on the role of EHR use on care coordination and quality improvement that are broadly applicable across the nation. In the current clinical environment, where care provided to patients is increasingly fragmented, and also increasingly complex, effective care coordination is essential.