电子病历的实施：在按绩效付费环境下对预防服务提供的影响。
Implementation of electronic medical records: effect on the provision of preventive services in a pay-for-performance environment.
机构信息
Department of Family and Community Medicine, University of Toronto, Ontario, Canada.
出版信息
Can Fam Physician. 2011 Oct;57(10):e381-9.
Abstract
OBJECTIVE
To study the effect of electronic medical record (EMR) implementation on preventive services covered by Ontario's pay-for-performance program.
DESIGN
Prospective double-cohort study.
PARTICIPANTS
Twenty-seven community-based family physicians.
SETTING
Toronto, Ont.
INTERVENTION
Eighteen physicians implemented EMRs, while 9 physicians continued to use paper records.
MAIN OUTCOME MEASURE
Provision of 4 preventive services affected by pay-for-performance incentives (Papanicolaou tests, screening mammograms, fecal occult blood testing, and influenza vaccinations) in the first 2 years of EMR implementation.
RESULTS
After adjustment, combined preventive services for the EMR group increased by 0.7%, a smaller increase than that seen in the non-EMR group (P = .55, 95% confidence interval -2.8 to 3.9).
CONCLUSION
When compared with paper records, EMR implementation had no significant effect on the provision of the 4 preventive services studied.
摘要
目的
研究电子病历（EMR）实施对安大略省按绩效付费计划涵盖的预防服务的影响。
设计
前瞻性双队列研究。
参与者
27 位社区为基础的家庭医生。
地点
安大略省多伦多市。
干预措施
18 位医生实施了电子病历，而 9 位医生继续使用纸质记录。
主要观察指标
实施 EMR 的头 2 年内，受按绩效付费激励影响的 4 种预防服务（巴氏涂片检查、乳房 X 光筛查、粪便潜血试验和流感疫苗接种）的提供情况。
结果
调整后，EMR 组的综合预防服务增加了 0.7%，增幅小于非 EMR 组（P=.55，95%置信区间-2.8 至 3.9）。
结论
与纸质记录相比，EMR 的实施对所研究的 4 种预防服务的提供没有显著影响。
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