The Benefit and Burden of Electronic Reminders for Optimizing Patient Care

描述(由申请人提供)：卫生信息技术(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的相关信息，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限制，有明显的可能性，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。如果不能更好地了解HIT系统中呈现的各种信息是如何影响患者护理的，就不可能建立HIT系统-- 每年投资350亿美元的企业--以优化患者护理。长期目标是 使用真实医疗保健系统的数据开发经验方法，以确定HIT系统的重要设计余量对实际患者护理和健康的影响。这一具体应用的目标是定量测量退伍军人健康管理局(VHA)内130个医疗保健系统中电子提醒系统的主要变化特征，然后使用这些测量来估计增加提醒系统的信息内容对提供的初级保健质量的影响。使用与提醒相关的信息项计数的初步数据表明，提醒系统之间的差异很大。根据卫生保健系统和时间的不同，照顾同一患者的同一提供者可能被要求处理5或40条关于预防护理和疾病管理的提醒相关信息。我将通过追求三个具体目标来实现这一目标：(1)量化VHA医疗保健系统中电子提醒集随时间的差异。除了使用信息项计数的初步证据外，我还将定量测量提醒系统信息内容的其他方面的差异(例如，主题广度、复杂性和可理解性)。(2)利用提交给临床医生的一组提醒的自然实验，估计初级保健质量措施对提醒的信息内容的剂量响应。(3)确定对提醒信息内容的剂量响应如何取决于患者、提供者和组织环境。使用管理患者和提供者级别的数据、提供者董事会评分的外部数据和组织级别的调查，我将检查这些特征描述的不同背景下对提醒的响应有何不同。该方法在使用详细的管理数据、HIT系统中呈现的信息内容的变化以及改变这种信息内容的自然实验方面具有创新性。这项拟议的研究具有重要意义，因为它代表着在考虑到提供者认知限制的情况下，朝着定义HIT中“正确的”信息量以优化患者护理迈出的第一步。需要在这一领域取得进展，以便能够评估和设计HIT系统，以优化患者护理。

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.