Lester William T, Ashburner Jeffrey M, Grant Richard W, Chueh Henry C, Barry Michael J, Atlas Steven J
Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, 7th Floor, Boston, Massachusetts 02114, USA.
J Am Med Inform Assoc. 2009 Mar-Apr;16(2):187-95. doi: 10.1197/jamia.M2813. Epub 2008 Dec 11.
Health care information technology can be a means to improve quality and efficiency in the primary care setting. However, merely applying technology without addressing how it fits into provider workflow and existing systems is unlikely to achieve improvement goals. Improving quality of primary care, such as cancer screening rates, requires addressing barriers at system, provider, and patient levels. The authors report the development, implementation, and preliminary use of a new breast cancer screening outreach program in a large multicenter primary care network. This installation paired population-based surveillance with customized information delivery based on a validated model linking patients to providers and practices. In the first six months, 86% of physicians and all case managers voluntarily participated in the program. Providers intervened in 83% of the mammogram-overdue population by initiating mailed reminders or deferring contact. Overall, 63% of patients were successfully contacted. Systematic population-based efforts are promising tools to improve preventative care.
医疗保健信息技术可以成为提高初级保健环境质量和效率的一种手段。然而,仅仅应用技术而不考虑其如何融入提供者工作流程和现有系统,不太可能实现改进目标。提高初级保健质量,如癌症筛查率,需要解决系统、提供者和患者层面的障碍。作者报告了在一个大型多中心初级保健网络中一个新的乳腺癌筛查推广项目的开发、实施和初步使用情况。该项目将基于人群的监测与基于经过验证的模型的定制信息传递相结合,该模型将患者与提供者及医疗实践联系起来。在头六个月里,86%的医生和所有病例管理人员自愿参与了该项目。提供者通过发送邮寄提醒或推迟联系,对83%的乳房X光检查逾期人群进行了干预。总体而言,63%的患者成功得到了联系。基于人群的系统性努力是改善预防保健的有前景的工具。