Vande Loo Sarah J, North Frederick
Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
BMC Med Inform Decis Mak. 2016 Apr 12;16:41. doi: 10.1186/s12911-016-0279-2.
Health care institutions have patient question sets that can expand over time. For a multispecialty group, each specialty might have multiple question sets. As a result, question set governance can be challenging. Knowledge of the counts, variability and repetition of questions in a multispecialty practice can help institutions understand the challenges of question set proliferation.
We analyzed patient-facing question sets that were subject to institutional governance and those that were not. We examined question variability and number of repetitious questions for a simulated episode of care. In addition to examining general patient question sets, we used specific examples of tobacco questions, questions from two specialty areas, and questions to menopausal women.
In our analysis, there were approximately 269 institutionally governed patient question sets with a mean of 74 questions per set accounting for an estimated 20,000 governed questions. Sampling from selected specialties revealed that 50 % of patient question sets were not institutionally governed. We found over 650 tobacco-related questions in use, many with only slight variations. A simulated use case for a menopausal woman revealed potentially over 200 repeated questions.
A group practice with multiple specialties can have a large volume of patient questions that are not centrally developed, stored or governed. This results in a lack of standardization and coordination. Patients may be given multiple repeated questions throughout the course of their care, and providers lack standardized question sets to help construct valid patient phenotypes. Even with the implementation of a single electronic health record, medical practices may still have a health information management gap in the ability to create, store and share patient-generated health information that is meaningful to both patients and physicians.
医疗机构拥有患者问题集，且这些问题集可能会随着时间推移而增加。对于一个多专科医疗团队而言，每个专科可能都有多个问题集。因此，问题集管理可能具有挑战性。了解多专科医疗实践中问题的数量、变异性和重复性，有助于医疗机构理解问题集激增所带来的挑战。
我们分析了受机构管理的面向患者的问题集以及不受机构管理的问题集。我们针对一个模拟的护理过程，研究了问题的变异性和重复问题的数量。除了研究一般患者问题集外，我们还使用了烟草问题的具体示例、两个专科领域的问题以及针对更年期女性的问题。
在我们的分析中，约有269个受机构管理的患者问题集，平均每个问题集有74个问题，总计约20000个受管理的问题。从选定专科抽样显示，50%的患者问题集不受机构管理。我们发现有超过650个与烟草相关的问题在使用，其中许多问题只有细微差别。一个针对更年期女性的模拟用例显示可能有超过200个重复问题。
一个拥有多个专科的医疗团队可能有大量未集中开发、存储或管理的患者问题。这导致缺乏标准化和协调性。在患者的整个护理过程中，他们可能会被多次问到重复问题，而且医疗服务提供者缺乏标准化的问题集来帮助构建有效的患者表型。即使实施了单一的电子健康记录，医疗实践在创建、存储和共享对患者和医生都有意义的患者生成的健康信息方面，可能仍然存在健康信息管理差距。
