Center for Innovation in Access and Quality, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
Am J Med. 2013 Aug;126(8):732-8. doi: 10.1016/j.amjmed.2013.02.017. Epub 2013 Jun 18.
Effective communication between primary care providers and specialty providers is important to facilitate high-quality specialty care. Few studies have assessed the quality of communication from specialist to primary care providers or implemented interventions to improve quality. We developed a brief, low-cost intervention designed to improve the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners in our urban health care system.
Six physicians (3 specialists and 3 primary care providers) scored pre- and postintervention notes using an objective quality assessment instrument that had excellent inter-rater reliability. They were blinded to note date, author, and pre/postintervention status. The primary outcome was improvement in Composite Quality Score, an objective, comprehensive assessment of quality. Secondary outcomes included improvements in 3 specific domains, and Global Quality Score (a subjective measure of quality).
Two hundred pre- and 200 postintervention notes written by 6 fellows and 2 nurse practitioners were included. Composite Quality Score improved from 3.74 (of 5) to 4.09 (P <.001 in adjusted analysis). All secondary outcomes improved in adjusted analyses as well. The largest increase was seen in Communication Domain (22% increase). Fellow-written notes had higher scores than nurse practitioner-written notes, but nurse practitioner-written notes improved to a greater degree.
A brief, low-cost intervention significantly improved the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners. Communication between primary care providers and specialists is an important area for further study.
初级保健提供者和专科提供者之间的有效沟通对于促进高质量的专科护理至关重要。很少有研究评估专家向初级保健提供者传达信息的质量，也很少有研究实施干预措施来提高质量。我们开发了一种简短、低成本的干预措施，旨在提高我们城市卫生保健系统中住院医师和执业护士撰写的门诊胃肠病学咨询记录的质量。
6 名医生（3 名专家和 3 名初级保健提供者）使用客观质量评估工具对干预前后的记录进行评分，该工具具有出色的组内可靠性。他们对记录日期、作者和干预前后状态均不知情。主要结果是综合质量评分的改善，这是对质量的客观、全面评估。次要结果包括 3 个特定领域和整体质量评分（质量的主观测量）的改善。
共纳入 6 名住院医师和 2 名执业护士撰写的 200 份干预前和 200 份干预后记录。综合质量评分从 3.74（满分 5 分）提高到 4.09（调整分析中 P <.001）。所有次要结果在调整分析中均有所改善。沟通领域的改善最大（增加 22%）。住院医师撰写的记录得分高于执业护士撰写的记录，但执业护士撰写的记录提高的幅度更大。
一项简短、低成本的干预措施显著提高了住院医师和执业护士撰写的门诊胃肠病学咨询记录的质量。初级保健提供者和专家之间的沟通是进一步研究的重要领域。
