电子临床评估练习（e-CEX）：一种新的以患者为中心的电子健康记录使用工具。

Electronic-clinical evaluation exercise (e-CEX): A new patient-centered EHR use tool.

机构信息

Department of Academic Pediatrics, University of Chicago, Chicago, United States.

Department of Medicine, University of Chicago, Chicago, United States.

出版信息

Patient Educ Couns. 2018 Mar;101(3):481-489. doi: 10.1016/j.pec.2017.10.005. Epub 2017 Oct 10.

DOI:10.1016/j.pec.2017.10.005

PMID:29042145

Abstract

INTRODUCTION

Electronic Health Record (EHR) use can enhance or weaken patient-provider communication. Despite EHR adoption, no validated tool exists to assess EHR communication skills. We aimed to develop and validate such a tool.

METHODS

Electronic-Clinical Evaluation Exercise (e-CEX) is a 10-item-tool based on systematic literature review and pilot-testing. Second-year (MS2s) students participated in an EHR-use lecture and structured Clinical Examination (OSCE). Untrained third-year students (MS3s) participated in the same OSCE. OSCEs were scored with e-CEX compared to a standardized patient (SP) tool. Internal consistency, discriminant validity, and concurrent validity were analyzed.

RESULTS

Three investigators used e-CEX to rate 70 videos (20 MS2, 50 MS3). Reliability testing indicated high internal consistency (Cronbach's alpha=0.89). MS2s scored significantly higher than untrained MS3s on e-CEX [e-CEX 55(10.7) vs. 44.9 (12.7), P=0.003], providing evidence of discriminant validity. e-CEX and SP score correlation was high (Pearson correlation=0.74, P<0.001), providing concurrent validity evidence. Item reduction suggested a three-item tool had similar explanatory power (R-squared=0.85 vs 0.86).

CONCLUSION

e-CEX is a reliable, valid tool to assess medical student patient-centered EHR communication skills.

PRACTICE IMPLICATIONS

While validation is needed with other healthcare providers, e-CEX may help improve provider behaviors and enhance patients' overall experience of EHR use in their care.

摘要

简介

电子健康记录（EHR）的使用可以增强或削弱医患沟通。尽管已经采用了 EHR，但目前还没有经过验证的工具来评估 EHR 的沟通技巧。我们旨在开发和验证这样的工具。

方法

电子临床评估练习（e-CEX）是一种基于系统文献回顾和试点测试的 10 项工具。二年级（MS2）学生参加了 EHR 使用讲座和结构化临床考试（OSCE）。未经训练的三年级（MS3）学生参加了相同的 OSCE。OSCE 的评分与电子临床评估练习（e-CEX）相比，与标准化患者（SP）工具进行比较。分析了内部一致性、判别有效性和同时有效性。

结果

三名研究人员使用 e-CEX 对 70 个视频（20 个 MS2，50 个 MS3）进行评分。可靠性测试表明，内部一致性高（Cronbach's alpha=0.89）。MS2 的得分明显高于未经训练的 MS3，e-CEX [e-CEX 55（10.7）与 44.9（12.7），P=0.003]，具有判别有效性的证据。e-CEX 和 SP 评分相关性高（Pearson 相关系数=0.74，P<0.001），提供同时有效性的证据。项目减少表明三项目工具具有相似的解释能力（R 平方=0.85 与 0.86）。