Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612. Email:
Am J Manag Care. 2020 Oct 1;26(10):e327-e332. doi: 10.37765/ajmc.2020.88506.
Continuity of patient information across settings can improve transitions after hospital discharge, but outpatient clinicians often have limited access to complete information from recent hospitalizations. We examined whether providers' timely access to clinical information through shared inpatient-outpatient electronic health records (EHRs) was associated with follow-up visits, return emergency department (ED) visits, or readmissions after hospital discharge in patients with diabetes.
Stepped-wedge observational study.
As an integrated delivery system staggered implementation of a shared inpatient-outpatient EHR, we studied 241,510 hospital discharges in patients with diabetes (2005-2011), examining rates of outpatient follow-up office visits, telemedicine (phone visits and asynchronous secure messages), laboratory tests, and return ED visits or readmissions (as adverse events). We used multivariate logistic regression adjusting for time trends, patient characteristics, and medical center and accounting for patient clustering to calculate adjusted follow-up rates.
For patients with diabetes, provider use of a shared inpatient-outpatient EHR was associated with a statistically significant shift toward follow-up delivered through a combination of telemedicine and outpatient laboratory tests, without a traditional in-person visit (from 22.9% with an outpatient-only EHR to 27.0% with a shared inpatient-outpatient EHR; P < .05). We found no statistically significant differences in 30-day return ED visits (odds ratio, 1.02; 95% CI, 0.96-1.09) or readmissions (odds ratio, 0.98; 95% CI, 0.91-1.06) with the shared EHR compared with the outpatient-only EHR.
Real-time clinical information availability during transitions between health care settings, along with robust telemedicine access, may shift the method of care delivery without adversely affecting patient health outcomes. Efforts to expand interoperability and information exchange may support follow-up care efficiency.
在医疗机构之间传递患者信息可以改善出院后的转归，但门诊临床医生通常无法获取近期住院的完整信息。我们探讨了在糖尿病患者中，临床医生能否及时通过共享的住院-门诊电子健康记录（EHR）获取临床信息，这与出院后的随访就诊、返回急诊部（ED）就诊或再入院之间的关系。
分步式观察性研究。
作为一个综合医疗服务体系，我们分步实施了共享的住院-门诊 EHR。我们研究了 241510 例糖尿病患者的出院情况（2005-2011 年），评估了门诊随访就诊、远程医疗（电话就诊和异步安全消息）、实验室检查的比例，以及返回 ED 就诊或再入院（作为不良事件）的比例。我们使用多变量逻辑回归，调整了时间趋势、患者特征、医疗中心，并考虑了患者聚类，计算了调整后的随访率。
对于糖尿病患者，临床医生使用共享的住院-门诊 EHR 与通过远程医疗和门诊实验室检查相结合的方式进行随访的比例呈显著上升趋势，而无需传统的面对面就诊（从仅门诊 EHR 的 22.9%上升至共享住院-门诊 EHR 的 27.0%；P<.05）。与仅门诊 EHR 相比，我们未发现 30 天内返回 ED 就诊（优势比，1.02；95%置信区间，0.96-1.09）或再入院（优势比，0.98；95%置信区间，0.91-1.06）有统计学显著差异。
在医疗保健环境之间的转归中实时获取临床信息，以及强大的远程医疗访问，可能会改变护理提供方式，而不会对患者的健康结果产生不利影响。扩大互操作性和信息交换的努力可能会支持随访护理的效率。
