基于电子健康记录的干预措施对改善异常病理结果随访效果的回顾性记录分析。
Effectiveness of an electronic health record-based intervention to improve follow-up of abnormal pathology results: a retrospective record analysis.
机构信息
Houston VA Health Services Research & Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
出版信息
Med Care. 2012 Oct;50(10):898-904. doi: 10.1097/MLR.0b013e31825f6619.
BACKGROUND AND OBJECTIVE
On March 11, 2009, the Veterans Health Administration (VA) implemented an electronic health record (EHR)-based intervention that required all pathology results to be transmitted to ordering providers by mandatory automated notifications. We examined the impact of this intervention on improving follow-up of abnormal outpatient pathology results.
RESEARCH DESIGN AND SUBJECTS
We extracted pathology reports from the EHR of 2 VA sites. From 16,738 preintervention and 17,305 postintervention reports between 09/01/2008 and 09/30/2009, we randomly selected about 5% and evaluated follow-up outcomes using a standardized chart review instrument. Documented responses to the alerted report (eg, ordering follow-up tests or referrals, notifying patients, and prescribing/changing treatment) were recorded.
MEASURES
Primary outcome measures included proportion of timely follow-up responses (within 30 d) and median time to direct response for abnormal reports.
RESULTS
Of 816 preintervention and 798 postintervention reports reviewed, 666 (81.6%) and 688 (86.2%) were abnormal. Overall, there was no apparent intervention effect on timely follow-up (69% vs. 67.1%; P=0.4) or median time to direct response (8 vs. 8 d; P=0.7). However, logistic regression uncovered a significant intervention effect (preintervention odds ratio, 0.7; 95% confidence interval, 0.5-1.0) after accounting for site-specific differences in follow-up, with a lower likelihood of timely follow-up at one site (odds ratio, 0.4; 95% confidence interval, 0.2-0.7).
CONCLUSIONS
An electronic intervention to improve test result follow-up at 2 VA institutions using the same EHR was found effective only after accounting for certain local contextual factors. Aggregating the effect of EHR interventions across different institutions and EHRs without controlling for contextual factors might underestimate their potential benefits.
背景与目的
2009 年 3 月 11 日，退伍军人健康管理局（VA）实施了一项基于电子健康记录（EHR）的干预措施，要求通过强制性自动通知将所有病理结果传输给开单医生。我们研究了该干预措施对改善异常门诊病理结果的随访情况的影响。
研究设计与对象
我们从 2 个 VA 站点的 EHR 中提取了病理报告。在 2008 年 9 月 1 日至 2009 年 9 月 30 日期间，我们从 16738 份干预前和 17305 份干预后报告中随机选择了约 5%，并使用标准化图表审查工具评估了随访结果。记录了对警报报告的书面回复（例如，开单进行后续检查或转诊、通知患者和开处方/更改治疗）。
测量
主要观察指标包括及时回复（30d 内）的比例和异常报告直接回复的中位数时间。
结果
在 816 份干预前和 798 份干预后报告中，666 份（81.6%）和 688 份（86.2%）为异常报告。总体而言，及时随访（69%对 67.1%；P=0.4）或直接回复中位数时间（8 对 8d；P=0.7）均未显示出明显的干预效果。然而，在考虑到随访方面的站点特异性差异后，逻辑回归发现干预存在显著效果（干预前比值比为 0.7；95%置信区间为 0.5-1.0），在一个站点及时随访的可能性较低（比值比为 0.4；95%置信区间为 0.2-0.7）。
结论
在使用相同 EHR 的 2 个 VA 机构中，一项旨在改善检验结果随访的电子干预措施被发现只有在考虑到某些局部环境因素后才有效。如果不控制环境因素，汇总不同机构和 EHR 中电子干预措施的效果可能会低估其潜在益处。
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