Kurtzman Gregory, Dine Jessica, Epstein Andrew, Gitelman Yevgenly, Leri Damien, Patel Miltesh S, Ryskina Kyra
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Hosp Med. 2017 Sep;12(9):743-746. doi: 10.12788/jhm.2811.
The objective of this study was to measure internal medicine resident engagement with an electronic medical record-based dashboard providing feedback on their use of routine laboratory tests relative to service averages. From January 2016 to June 2016, residents were e-mailed a snapshot of their personalized dashboard, a link to the online dashboard, and text summarizing the resident and service utilization averages. We measured resident engagement using e-mail read-receipts and web-based tracking. We also conducted 3 hour-long focus groups with residents. Using grounded theory approach, the transcripts were analyzed for common themes focusing on barriers and facilitators of dashboard use. Among 80 residents, 74% opened the e-mail containing a link to the dashboard and 21% accessed the dashboard itself. We did not observe a statistically significant difference in routine laboratory ordering by dashboard use, although residents who opened the link to the dashboard ordered 0.26 fewer labs per doctor-patient-day than those who did not (95% confidence interval, -0.77 to 0.25; 𝑃 = 0 .31). While they raised several concerns, focus group participants had positive attitudes toward receiving individualized feedback delivered in real time.
本研究的目的是衡量内科住院医师对基于电子病历的仪表板的参与度，该仪表板可提供他们相对于科室平均水平的常规实验室检查使用情况的反馈。2016年1月至2016年6月，通过电子邮件向住院医师发送了其个性化仪表板的快照、在线仪表板的链接以及总结住院医师和科室使用情况平均值的文本。我们使用电子邮件阅读回执和基于网络的跟踪来衡量住院医师的参与度。我们还与住院医师进行了3次为时1小时的焦点小组讨论。采用扎根理论方法，对记录进行分析，以找出关注仪表板使用障碍和促进因素的共同主题。在80名住院医师中，74%打开了包含仪表板链接的电子邮件，21%访问了仪表板本身。尽管打开仪表板链接的住院医师每位医生-患者日的实验室检查订单比未打开链接的住院医师少0.26份（95%置信区间，-0.77至0.25；P = 0.31），但我们未观察到使用仪表板对常规实验室检查订单有统计学上的显著差异。虽然焦点小组参与者提出了一些担忧，但他们对实时收到个性化反馈持积极态度。
