自动化通知对出院时待处理可行动测试的随访的影响：一项整群随机对照试验。
The Impact of Automated Notification on Follow-up of Actionable Tests Pending at Discharge: a Cluster-Randomized Controlled Trial.
机构信息
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Hospital Medicine Unit, Brigham and Women's Hospital, Boston, MA, USA.
出版信息
J Gen Intern Med. 2018 Jul;33(7):1043-1051. doi: 10.1007/s11606-018-4393-y. Epub 2018 Mar 12.
BACKGROUND
Follow-up of tests pending at discharge (TPADs) is poor. We previously demonstrated a twofold increase in awareness of any TPAD by attendings and primary care physicians (PCPs) using an automated email intervention OBJECTIVE: To determine whether automated notification improves documented follow-up for actionable TPADs DESIGN: Cluster-randomized controlled trial SUBJECTS: Attendings and PCPs caring for adult patients discharged from general medicine and cardiology services with at least one actionable TPAD between June 2011 and May 2012 INTERVENTION: An automated system that notifies discharging attendings and network PCPs of finalized TPADs by email MAIN MEASURES: The primary outcome was the proportion of actionable TPADs with documented action determined by independent physician review of the electronic health record (EHR). Secondary outcomes included documented acknowledgment, 30-day readmissions, and adjusted median days to documented follow-up.
KEY RESULTS
Of the 3378 TPADs sampled, 253 (7.5%) were determined to be actionable by physician review. Of these, 150 (123 patients discharged by 53 attendings) and 103 (90 patients discharged by 44 attendings) were assigned to intervention and usual care groups, respectively, and underwent chart review. The proportion of actionable TPADs with documented action was 60.7 vs. 56.3% (p = 0.82) in the intervention vs. usual care groups, similar for documented acknowledgment. The proportion of patients with actionable TPADs readmitted within 30 days was 22.8 vs. 31.1% in the intervention vs. usual care groups (p = 0.24). The adjusted median days [95% CI] to documented action was 9 [6.2, 11.8] vs. 14 [10.2, 17.8] (p = 0.04) in the intervention vs. usual care groups, similar for documented acknowledgment. In sub-group analysis, the intervention had greater impact on documented action for patients with network PCPs compared with usual care (70 vs. 50%, p = 0.03).
CONCLUSIONS
Automated notification of actionable TPADs shortened time to action but did not significantly improve documented follow-up, except for network-affiliated patients. The high proportion of actionable TPADs without any documented follow-up (~ 40%) represents an ongoing safety concern.
CLINICAL TRIALS IDENTIFIER
NCT01153451.
背景
出院时待处理的检查（TPAD）的随访情况很差。我们之前通过使用自动电子邮件干预措施，使主治医生和初级保健医生（PCP）对任何 TPAD 的意识提高了一倍。
目的
确定自动通知是否可以改善可操作的 TPAD 的记录随访。
设计
集群随机对照试验。
受试者
在 2011 年 6 月至 2012 年 5 月期间，接受普通内科和心脏病学服务出院的成年患者中，至少有一个可操作的 TPAD 的主治医生和 PCP。
干预措施
通过电子邮件向主治医生和网络 PCP 自动通知最终的 TPAD 的系统。
主要测量指标
主要结果是通过对电子病历（EHR）进行独立医生审查确定的可操作 TPAD 的记录行动的比例。次要结果包括记录确认、30 天再入院和调整的记录随访中位数天数。
结果
在抽样的 3378 个 TPAD 中，有 253 个（7.5%）通过医生审查被确定为可操作。其中，150 个（由 53 名主治医生出院的 123 名患者）和 103 个（由 44 名主治医生出院的 90 名患者）分别被分配到干预组和常规护理组，并进行了图表审查。在干预组和常规护理组中，有记录的可操作 TPAD 的记录行动的比例分别为 60.7%和 56.3%（p=0.82），记录确认也相似。在干预组和常规护理组中，30 天内再入院的可操作 TPAD 患者的比例分别为 22.8%和 31.1%（p=0.24）。调整后的记录行动中位数天数[95%CI]在干预组为 9 [6.2，11.8]，在常规护理组为 14 [10.2，17.8]（p=0.04），记录确认也相似。在亚组分析中，与常规护理相比，干预措施对有网络 PCP 的患者的记录行动有更大的影响（70%比 50%，p=0.03）。
结论
自动通知可操作的 TPAD 缩短了行动时间，但除了与网络相关的患者外，并没有显著改善记录的随访。大约 40%的无任何记录的可操作 TPAD 代表了持续存在的安全隐患。
临床试验标识符
NCT01153451。
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