Department of Biomedical Informatics, Columbia University, New York, NY, United States.
School of Nursing, Columbia University, New York, NY, United States.
Int J Med Inform. 2020 May;137:104099. doi: 10.1016/j.ijmedinf.2020.104099. Epub 2020 Feb 13.
The growing number of individuals with complex medical and social needs has motivated the adoption of care management (CM) - programs wherein multidisciplinary teams coordinate and monitor the clinical and non-clinical aspects of care for patients with chronic disease. Despite claims that health information technology (IT) is essential to CM, there has been limited research focused on the IT needs of clinicians providing care management to large groups of patients with chronic disease.
To assess clinicians' needs pertaining to CM and to identify inefficiencies and bottlenecks associated with the delivery of CM to large groups of patients with chronic disease.
A qualitative study of two HIV care programs. Methods included observations of multidisciplinary care team meetings and semi-structured interviews with physicians, care managers, and social workers. Thematic analysis was conducted to analyze the data.
CM was perceived by staff as requiring the development of novel strategies including patient prioritization and patient monitoring, which was supported by patient registries but also required the creation of additional homegrown tools. Common challenges included: limited ability to identify pertinent patient information, specifically in regards to social and behavioral determinants of health, limited assistance in matching patients to appropriate interventions, and limited support for communication within multidisciplinary care teams.
Clinicians delivering care management to chronic disease patients are not adequately supported by electronic health records and patient registries. Tools that better enable population monitoring, facilitate communication between providers, and help address psychosocial barriers to treatment could enable more effective care.
越来越多的人需要复杂的医疗和社会服务，这促使人们采用了照护管理（CM）项目，即多学科团队共同协调和监测慢性病患者的临床和非临床护理。尽管有人声称健康信息技术（IT）对于 CM 至关重要，但针对为大量慢性病患者提供照护管理的临床医生的 IT 需求，相关研究却十分有限。
评估临床医生在 CM 方面的需求，并确定与向大量慢性病患者提供 CM 相关的低效率和瓶颈问题。
对两个 HIV 护理项目进行了定性研究。方法包括观察多学科护理团队会议和对医生、照护管理人员以及社会工作者的半结构化访谈。采用主题分析法对数据进行分析。
工作人员认为 CM 需要制定新的策略，包括患者优先级排序和患者监测，而这需要患者注册系统的支持，但也需要创建其他内部工具。常见的挑战包括：难以识别相关患者信息，特别是在健康的社会和行为决定因素方面；难以帮助患者匹配合适的干预措施；以及在多学科护理团队内部的沟通支持有限。
为慢性病患者提供照护管理的临床医生无法充分利用电子健康记录和患者注册系统。能够更好地实现人群监测、促进提供者之间沟通以及帮助解决治疗中社会心理障碍的工具，可以实现更有效的护理。
