The effect of problem-oriented medical records on clinical management controlled for patient risks.

This study examines the change in clinical management by 28 medical and surgical firms in three London teaching hospitals following the introduction of Problem-Oriented Medical Records (POMR) in one of the hospitals. Comparison is made between firms using and not using POMR. The data are analyzed using a regression model. Analysis is based on the coefficient of change in each firm between the two study years when modified by the physiological and demographic patient variables significantly associated with the management of each disease. Although not conclusive, the results in four of the seven diseases studied encourage the speculation that POMR may have improved the thoroughness of patient management. The significant patient variables in each diagnosis suggest that patient risk on admission can affect management scores. Were this to be found elsewhere, the influences of patient mix might be considered in using explicit criteria to make comparisons between hospitals that serve different kinds of populations.