Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
BMC Med Inform Decis Mak. 2012 Apr 13;12:32. doi: 10.1186/1472-6947-12-32.
Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices.
METHODS/DESIGN: Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention.
PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38,000 patient surveys.
Many primary care physicians were willing to participate in this "real world" experiment testing the impact of OpenNotes on their patients and their practices. Results from this trial will inform providers, policy makers, and patients who contemplate such changes at a time of exploding interest in transparency, patient safety, and improving the quality of care.
医疗服务提供方和决策者正在寻找各种策略来增加患者对医疗服务的参与度。越来越多的医疗记录的线上部分可供患者查看，但很少有临床医生的就诊记录包含在内。我们设计了一项为期一年的多地点试验，旨在让患者在线查看医生的门诊记录，即 OpenNotes。我们假设患者和初级保健医生（PCP）希望继续实施该项目，并且 OpenNotes 不会对医生的实践造成显著干扰。
方法/设计：我们采用混合方法设计，在波士顿、宾夕法尼亚州和西雅图的 3 个不同医疗保健系统中进行了一项准实验研究。其中 2 个地点已经有了现有的患者互联网门户；第三个地点使用了一个实验性门户。我们将目标锁定在我们认为影响最大的 3 个关键领域：对 OpenNotes 的看法和态度、患者对互联网门户的使用情况以及医患沟通。邀请 3 个地点的 PCP 参与干预。参与 PCP 的注册门户用户将在一年内获得其 PCP 的就诊记录。拒绝参与干预的 PCP 及其患者则作为该研究的对照组。我们将 RE-AIM 框架应用于我们的设计中，以便尽可能全面地了解 OpenNotes 的影响。我们根据对患者和医生的访谈和焦点小组，为在线管理制定了干预前后的调查，以了解态度和经验。此外，我们还在干预前后跟踪了互联网门户的使用情况。
3 个地点的 PCP 参与率从 19%到 87%不等；共有 114 名 PCP 参与了干预，他们的 22000 名注册门户用户也参与了干预。3 个地点的大约 40%的干预组和非干预组患者对在线调查做出了回应，共收到大约 38000 份患者调查。
许多初级保健医生愿意参与这项“真实世界”实验，以测试 OpenNotes 对他们的患者及其实践的影响。该试验的结果将为那些在透明度、患者安全和提高医疗质量方面兴趣日益浓厚的提供者、政策制定者和患者提供信息。
