Department of Gastrointestinal Surgery, University Hospital North Norway, Tromsø, Norway ; Department of Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway ; Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Department of Gastrointestinal Surgery, University Hospital North Norway, Tromsø, Norway ; Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
J Multidiscip Healthc. 2014 Sep 9;7:371-80. doi: 10.2147/JMDH.S66693. eCollection 2014.
Poor coordination between levels of care plays a central role in determining the quality and cost of health care. To improve patient coordination, systematic structures, guidelines, and processes for creating, transferring, and recognizing information are needed to facilitate referral routines.
Prospective observational survey of implementation of electronic medical record (EMR)-supported guidelines for surgical treatment.
One university clinic, two local hospitals, 31 municipalities, and three EMR vendors participated in the implementation project. Surgical referral guidelines were developed using the Delphi method; 22 surgeons and seven general practitioners (GPs) needed 109 hours to reach consensus. Based on consensus guidelines, an electronic referral service supported by a clinical decision support system, fully integrated into the GPs' EMR, was developed. Fifty-five information technology personnel and 563 hours were needed (total cost 67,000 £) to implement a guideline supported system in the EMR for 139 GPs. Economical analyses from a hospital and societal perspective, showed that 504 (range 401-670) and 37 (range 29-49) referred patients, respectively, were needed to provide a cost-effective service.
A considerable amount of resources were needed to reach consensus on the surgical referral guidelines. A structured approach by the Delphi method and close collaboration between IT personnel, surgeons and primary care physicians were needed to reach consensus.
医疗服务各环节之间配合不佳是影响医疗质量和成本的核心因素。为了改善患者协调，需要创建、传递和识别信息的系统结构、指南和流程，以促进转诊流程。
前瞻性观察性研究，实施电子病历（EMR）支持的手术治疗指南。
一家大学诊所、两家地方医院、31 个市和三家 EMR 供应商参与了实施项目。使用德尔菲法制定了手术转诊指南；22 名外科医生和 7 名全科医生（GP）需要 109 小时才能达成共识。基于共识指南，开发了一个由临床决策支持系统支持的电子转诊服务，并完全集成到 GP 的 EMR 中。需要 55 名信息技术人员和 563 小时（总成本 67000 英镑）才能为 139 名 GP 在 EMR 中实施支持指南的系统。从医院和社会角度进行的经济分析表明，分别需要 504（范围 401-670）和 37（范围 29-49）名转诊患者，才能提供具有成本效益的服务。
就手术转诊指南达成共识需要大量资源。需要采用德尔菲法进行结构化的方法，并需要 IT 人员、外科医生和初级保健医生之间密切合作，才能达成共识。
