出院待检检验结果自动化电子邮件通知系统的影响：一项整群随机对照试验。
Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial.
机构信息
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
出版信息
J Am Med Inform Assoc. 2014 May-Jun;21(3):473-80. doi: 10.1136/amiajnl-2013-002030. Epub 2013 Oct 23.
BACKGROUND AND OBJECTIVE
Physician awareness of the results of tests pending at discharge (TPADs) is poor. We developed an automated system that notifies responsible physicians of TPAD results via secure, network email. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results.
METHODS
We conducted a cluster-randomized controlled trial at a major hospital affiliated with an integrated healthcare delivery network in Boston, Massachusetts. Adult patients with TPADs who were discharged from inpatient general medicine and cardiology services were assigned to the intervention or usual care arm if their inpatient attending physician and primary care physician (PCP) were both randomized to the same study arm. Patients of physicians randomized to discordant study arms were excluded. We surveyed these physicians 72 h after all TPAD results were finalized. The primary outcome was awareness of TPAD results by attending physicians. Secondary outcomes included awareness of TPAD results by PCPs, awareness of actionable TPAD results, and provider satisfaction.
RESULTS
We analyzed data on 441 patients. We sent 441 surveys to attending physicians and 353 surveys to PCPs and received 275 and 152 responses from 83 different attending physicians and 112 different PCPs, respectively (attending physician survey response rate of 63%). Intervention attending physicians and PCPs were significantly more aware of TPAD results (76% vs 38%, adjusted/clustered OR 6.30 (95% CI 3.02 to 13.16), p<0.001; 57% vs 33%, adjusted/clustered OR 3.08 (95% CI 1.43 to 6.66), p=0.004, respectively). Intervention attending physicians tended to be more aware of actionable TPAD results (59% vs 29%, adjusted/clustered OR 4.25 (0.65, 27.85), p=0.13). One hundred and eighteen (85%) and 43 (63%) intervention attending physician and PCP survey respondents, respectively, were satisfied with this intervention.
CONCLUSIONS
Automated email notification represents a promising strategy for managing TPAD results, potentially mitigating an unresolved patient safety concern.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov (NCT01153451).
背景与目的
医生对出院时待处理检验结果（TPADs）的知晓率较差。我们开发了一种自动化系统，通过安全的网络电子邮件向负责的医生通报 TPAD 结果。我们旨在评估该系统对负责医生对 TPAD 结果知晓率的影响，这是改善 TPAD 结果管理的必要中间步骤。
方法
我们在马萨诸塞州波士顿的一家主要医院进行了一项大型医院的集群随机对照试验，该医院隶属于一个综合性医疗服务网络。接受内科和心脏病学服务的住院患者出院时，如果他们的住院主治医生和初级保健医生（PCP）都被随机分配到相同的研究组，则被分配到干预组或常规护理组。如果主治医生被随机分配到不同的研究组，那么他们的患者将被排除在研究之外。我们在所有 TPAD 结果最终确定后的 72 小时内对这些医生进行了调查。主要结局是主治医生对 TPAD 结果的知晓率。次要结局包括 PCP 对 TPAD 结果的知晓率、对可操作 TPAD 结果的知晓率和提供者满意度。
结果
我们分析了 441 名患者的数据。我们向主治医生发送了 441 份调查问卷，向 PCP 发送了 353 份调查问卷，分别收到了 83 名不同主治医生和 112 名不同 PCP 的 275 份和 152 份回复（主治医生调查问卷的回复率为 63%）。干预组的主治医生和 PCP 对 TPAD 结果的知晓率明显更高（76%比 38%，调整后/聚类 OR 6.30（95%CI 3.02 至 13.16），p<0.001；57%比 33%，调整后/聚类 OR 3.08（95%CI 1.43 至 6.66），p=0.004）。干预组的主治医生更倾向于知晓可操作的 TPAD 结果（59%比 29%，调整后/聚类 OR 4.25（0.65，27.85），p=0.13）。分别有 118（85%）和 43（63%）名干预组主治医生和 PCP 调查应答者对该干预措施表示满意。
结论
自动化电子邮件通知是管理 TPAD 结果的一种很有前途的策略，可能减轻未解决的患者安全问题。
临床试验注册
ClinicalTrials.gov（NCT01153451）。
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